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WAL-MART PHARMACY 10-1505
CAH181331-00 APPALACHIAN REGIONAL HEALTHCARE INC. D/B/A MCDOWELL ARH HOSPITAL
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Covered Entity Details
Entity Name
APPALACHIAN REGIONAL HEALTHCARE INC. D/B/A MCDOWELL ARH HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181331-00
Entity Address
9879 KY RTE 122
MCDOWELL, KY 41647
Medicare Provider Number
181331
Participating Start Date
9/8/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1505
Pharmacy Address
254 CASSIDY BLVD.
PIKEVILLE, KY 41501
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/10/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/12/2019
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