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WAL-MART PHARMACY 10-1951
CAH131307-00 Weiser Valley Hospital District, dba Weiser Memorial Hospital
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Covered Entity Details
Entity Name
Weiser Valley Hospital District, dba Weiser Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131307-00
Entity Address
645 East 5th Street
Weiser, ID 83672
Medicare Provider Number
131307
Participating Start Date
7/1/2013
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1951
Pharmacy Address
1775 E IDAHO AVENUE
ONTARIO, OR 97914
Pharmacy Comments
Contract Details
Approval Date
1/11/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Hale, CEO
(208) 549-4450
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/11/2021
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