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WAL-MART PHARMACY 10-2809
CAH511321-00 ST. JOSEPHS HOSPITAL
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Covered Entity Details
Entity Name
ST. JOSEPHS HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511321-00
Entity Address
1 AMALIA DRIVE
BUCKHANNON, WV 26201
Medicare Provider Number
511321
Participating Start Date
10/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2809
Pharmacy Address
100 BUCKHANNON CROSSROADS
BUCKHANNON, WV 26201
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Russell J. Plywaczynski, Director of Finance
(304) 460-7955
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/12/2021
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