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GREYBULL DRUG, LLC
CAH531304-00 HOT SPRINGS COUNTY MEMORIAL
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Covered Entity Details
Entity Name
HOT SPRINGS COUNTY MEMORIAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH531304-00
Entity Address
150 EAST ARAPAHOE
THERMOPOLIS, WY 82443
Medicare Provider Number
531304
Participating Start Date
10/1/2017
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
GREYBULL DRUG, LLC
Pharmacy Address
925 N. 6TH ST
GREYBULL, WY 82426
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Margie Renee Pecks-Molitor, CEO
(307) 864-5034
Contract Pharmacy Representative
greybull drug
Ross Davidson, PIC
(307) 765-4601
Signed By Date
1/14/2020
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