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WAL-MART PHARMACY 10-3259
CAH271331-00 MINERAL COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
MINERAL COMMUNITY HOSPITAL
Subdivision Name
DBA Mineral Community Hospital
Type
Critical Access Hospital
340B ID
CAH271331-00
Entity Address
1208 6TH AVE EAST
SUPERIOR, MT 59872
Medicare Provider Number
271331
Participating Start Date
10/1/2019
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3259
Pharmacy Address
3555 MULLAN ROAD
MISSOULA, MT 59808
Pharmacy Comments
Contract Details
Approval Date
4/16/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Laurel Chambers Haskins, CEO
(406) 822-4841 Ext: 155
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/16/2020
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