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WAL-MART PHARMACY 10-1495
RRC360079-00 Kettering Health Main Campus
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Covered Entity Details
Entity Name
Kettering Health Main Campus
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360079-00
Entity Address
3535 SOUTHERN BOULEVARD
KETTERING, OH 45429
Medicare Provider Number
360079
Participating Start Date
7/1/2019
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1495
Pharmacy Address
7680 BRANDT PIKE
HUBER HEIGHTS, OH 45424
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/24/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Wendi Barber, Chief Financial Officer
(937) 395-8520
Contract Pharmacy Representative
Kettering Health Network:Grandview/Kettering/Ft Hamilton/Sycamore/Soin
Linda McCall, Pharmacy Director
(937) 458-4946
Signed By Date
7/13/2020
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