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WAL-MART PHARMACY 10-3807
CAH031301-00 BENSON HOSPITAL
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Covered Entity Details
Entity Name
BENSON HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031301-00
Entity Address
450 S. OCOTILLO
BENSON, AZ 85602-2990
Medicare Provider Number
031301
Participating Start Date
7/1/2019
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3807
Pharmacy Address
201 SOUTH PRICKLY PEAR AVENUE
BENSON, AZ 85602
Pharmacy Comments
Contract Details
Approval Date
10/5/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Teresa Vincifora, COO
(520) 720-6510
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/5/2020
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