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WAL-MART PHARMACY 10-1544
CAH511307-00 GRAFTON CITY HOSPITAL
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Covered Entity Details
Entity Name
GRAFTON CITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511307-00
Entity Address
1 Hospital Plaza
GRAFTON, WV 26354
Medicare Provider Number
511307
Participating Start Date
7/1/2011
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1544
Pharmacy Address
550 EMILY DRIVE
CLARKSBURG, WV 26301
Pharmacy Comments
Contract Details
Approval Date
7/9/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
George Charles Boyles, Chief Administrative Officer
(304) 265-7152
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/9/2021
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