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WAL-MART PHARMACY 10-3282
CAH361330-00 HOCKING VALLEY COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
HOCKING VALLEY COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361330-00
Entity Address
601 State Route 664 N
LOGAN, OH 43138
Medicare Provider Number
361330
Participating Start Date
8/10/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3282
Pharmacy Address
12910 STATE ROUTE 664
LOGAN, OH 43138
Pharmacy Comments
Contract Details
Approval Date
4/12/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julie E Grow, CFO
(740) 380-8389
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/12/2022
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