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WAL-MART CENTRAL FILL 10-2670
CAH201313-00 Sebasticook Valley Health
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Covered Entity Details
Entity Name
Sebasticook Valley Health
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201313-00
Entity Address
447 NORTH MAIN STREET
PITTSFIELD, ME 04967
Medicare Provider Number
201313
Participating Start Date
7/1/2011
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RANDALL CLARK, PRESIDENT
(207) 487-4022
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/14/2020
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