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WAL-MART PHARMACY 10-2044
DSH050133 RIDEOUT MEMORIAL HOSPITAL DBA Adventist Health and Rideout
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Covered Entity Details
Entity Name
RIDEOUT MEMORIAL HOSPITAL DBA Adventist Health and Rideout
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050133
Entity Address
726 4TH STREET
MARYSVILLE, CA 95901
Medicare Provider Number
050133
Participating Start Date
7/2/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2044
Pharmacy Address
2044 FOREST AVENUE
CHICO, CA 95928
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
5/14/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Ownership change
Contacts
Covered Entity Signing Official
Ed Gonzalez, CFO
(530) 751-4010
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/15/2019
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