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WAL-MART CENTRAL FILL 10-2670
CH033080 RAINELLE MEDICAL CENTER
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Covered Entity Details
Entity Name
RAINELLE MEDICAL CENTER
Subdivision Name
RAINELLE MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH033080
Entity Address
176 Medical Center Drive
Rainelle, WV 25962-1013
Grant Number
H80CS18278
Participating Start Date
4/1/1996
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
1/11/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KRISTI ATHA-RADER, CEO
(304) 438-6188 Ext: 1006
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/11/2022
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