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WAL-MART PHARMACY 10-1600
CAH051333-00 Ridgecrest Regional Hospital
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Covered Entity Details
Entity Name
Ridgecrest Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051333-00
Entity Address
1081 N. China Lake Blvd.
Ridgecrest, CA 93555
Medicare Provider Number
051333
Participating Start Date
10/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1600
Pharmacy Address
201 EAST BOWMAN RD.
RIDGECREST, CA 93555
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Suver, CEO
(760) 499-3902
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/10/2020
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