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WAL-MART PHARMACY 10-5315
CAH361326-00 ADAMS COUNTY HOSPITAL DBA ADAMS COUNTY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ADAMS COUNTY HOSPITAL DBA ADAMS COUNTY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361326-00
Entity Address
230 MEDICAL CENTER DRIVE
SEAMAN, OH 45679
Medicare Provider Number
361326
Participating Start Date
8/13/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
11/13/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/2/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pete R Dagenbach, CFO
(937) 386-3007
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
11/13/2020
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