Contract Pharmacy Details

WAL-MART PHARMACY 10-5470
CH030220 BROAD TOP AREA MEDICAL CENTER

Covered Entity Details

Entity Name

BROAD TOP AREA MEDICAL CENTER

Subdivision Name

Type

HRSA-Funded Health Center

340B ID

CH030220

Entity Address

RT 913
BROAD TOP, PA 16621-9001

Grant Number

H80CS00330

Participating Start Date

4/1/2003

Last Recertification Date

1/28/2020

Entity Termination Date

10/1/2020

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-5470

Pharmacy Address

6716 TOWN CENTER BLVD
HUNTINGDON, PA 16652

Pharmacy Comments

Contract Details

Approval Date

4/13/2012

Contract Begin Date

4/13/2012

Carve-In Effective Date

Contract Comments

4/8/14 unterminated CP, which was terminated as a result of the termination of the CE, which has since been unterminated;

Contract Termination Date
Termination Reason

2/24/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

GARY SAUERS, CEO
(814) 635-2916

Contract Pharmacy Representative

Wal--Mart
Marcus Osborne, Sales & Contracting
(479) 204-8452

Signed By Date

4/6/2012

340B Drug Pricing Program Database