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WALMART PHARMACY 10-6951
CH033100 CAMDEN-ON-GAULEY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
CAMDEN-ON-GAULEY MEDICAL CENTER, INC.
Subdivision Name
CAMDEN-ON-GAULEY MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH033100
Entity Address
10003 Webster Rd
Camden On Gauley, WV 26208
Grant Number
H80CS00078
Participating Start Date
12/1/1992
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-6951
Pharmacy Address
369 SCOTTS FORK-BONNIE RD
SUTTON, WV 26601
Pharmacy Comments
Contract Details
Approval Date
10/10/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Margaret Hickey, CEO
(304) 226-5725
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/10/2019
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