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WAL-MART PHARMACY 10-1301
CAH491302-00 CARILION GILES COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
CARILION GILES COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491302-00
Entity Address
159 HARTLEY WAY
PEARISBURG, VA 24134
Medicare Provider Number
491302
Participating Start Date
8/30/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1301
Pharmacy Address
5350 CLEARBROOK VILLAGE LN
ROANOKE, VA 24014
Pharmacy Comments
Contract Details
Approval Date
10/18/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/21/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William Flattery, VP Community Hospital, Administration
(540) 598-1933
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/18/2021
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