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WALMART PHARMACY 10-4276
RRC390001-00 COMMUNITY MEDICAL CENTER
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Covered Entity Details
Entity Name
COMMUNITY MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC390001-00
Entity Address
1800 MULBERRY STREET
SCRANTON, PA 18510
Medicare Provider Number
390001
Participating Start Date
1/1/2024
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4276
Pharmacy Address
1325 MAIN ST.
TAYLOR, PA 18517
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ron Beer, Chief Admiistrative Officer
(570) 808-5380
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2020
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