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WAL-MART PHARMACY 10-2329
CAH221303-00 Athol Memorial Hospital
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Covered Entity Details
Entity Name
Athol Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH221303-00
Entity Address
2033 Main St.
Athol, MA 01331
Medicare Provider Number
221303
Participating Start Date
4/1/2013
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2329
Pharmacy Address
555 EAST MAIN STREET
ORANGE, MA 01364
Pharmacy Comments
Contract Details
Approval Date
10/5/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Abbatiello, CFO
(978) 630-6157
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/5/2021
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