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WAL-MART PHARMACY 10-5253
RRC490120-00 CHESAPEAKE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
CHESAPEAKE GENERAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC490120-00
Entity Address
736 BATTLEFIELD BLVD. NORTH
CHESAPEAKE, VA 23320
Medicare Provider Number
490120
Participating Start Date
8/27/2021
Last Recertification Date
8/19/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5253
Pharmacy Address
632 GRASS FIELD PARKWAY
CHESAPEAKE (SW), VA 23322
Pharmacy Comments
Contract Details
Approval Date
8/6/2021
Contract Begin Date
8/27/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/17/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Reese Jackson, President and CEO
(757) 312-8121
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
8/6/2021
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