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WAL-MART PHARMACY 10-3850
CAH501304-00 Grays Harbor County Public Hospital District No. 1 DBA Summit Pacific Medical Center
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Covered Entity Details
Entity Name
Grays Harbor County Public Hospital District No. 1 DBA Summit Pacific Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501304-00
Entity Address
600 East Main St
Elma, WA 98541
Medicare Provider Number
501304
Participating Start Date
1/1/2015
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3850
Pharmacy Address
5900 LITTLEROCK RD. SW
TUMWATER, WA 98512
Pharmacy Comments
Contract Details
Approval Date
4/18/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Josh Martin, CEO
(360) 346-2244
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/18/2019
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