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WAL-MART PHARMACY 10-2249
CAH501319-00 LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH
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Covered Entity Details
Entity Name
LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501319-00
Entity Address
521 Adams Avenue
MORTON, WA 98356
Medicare Provider Number
501319
Participating Start Date
7/1/2011
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2249
Pharmacy Address
1601 NW LOUISIANA AVE
CHEHALIS, WA 98532
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Boggess, CHIEF FINANCIAL OFFICER
(360) 496-3647
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/12/2019
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