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WAL-MART PHARMACY 10-2262
CAH331311-03 Little Falls Hospital
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Covered Entity Details
Entity Name
Little Falls Hospital
Subdivision Name
Richfield Springs Health Center - Rural Health Clinic
Type
Critical Access Hospital
340B ID
CAH331311-03
Entity Address
8550 State Highway 28
Richfield Springs, NY 13439-4830
Medicare Provider Number
331311
Outpatient Facility Provider Number
333995
Participating Start Date
9/11/2020
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2262
Pharmacy Address
5054 STATE HWY 23
ONEONTA, NY 13820
Pharmacy Comments
Contract Details
Approval Date
9/11/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/11/2020
Agreement registered in error
Contacts
Covered Entity Signing Official
James Vielkind, CFO
(315) 823-5281
Contract Pharmacy Representative
Little Falls Hospital
Jamie Camardello, Pharmacist
(315) 823-5242
Signed By Date
9/11/2020
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