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WAL-MART PHARMACY 10-5315
CAH501321-01 NORTH VALLEY HOSPITAL
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Covered Entity Details
Entity Name
NORTH VALLEY HOSPITAL
Subdivision Name
OKANOGAN COUNTY PUBLIC HOSPITAL DIS - Tonasket Family Medical Clinic
Type
Critical Access Hospital
340B ID
CAH501321-01
Entity Address
118 N WHITCOMB AVE
TONASKET, WA 98855-8829
Medicare Provider Number
501321
Outpatient Facility Provider Number
508594
Participating Start Date
7/1/2021
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
4/11/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John McReynolds, CEO
(509) 486-3128
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/11/2022
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