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WAL-MART PHARMACY 10-1113
CAH181329-00 SAINT JOSEPH BEREA HOSPITAL
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Covered Entity Details
Entity Name
SAINT JOSEPH BEREA HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181329-00
Entity Address
305 ESTILL STREET
BEREA, KY 40403
Medicare Provider Number
181329
Participating Start Date
9/30/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1113
Pharmacy Address
1851 WEST HWY 192
LONDON, KY 40741
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
12/31/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sandra Rose, Vice President of Operations
(859) 986-6559
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/16/2020
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