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WAL-MART PHARMACY 10-5997
CAH491300-00 Bath County Community Hospital, Inc.
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Covered Entity Details
Entity Name
Bath County Community Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491300-00
Entity Address
106 Park Drive
Hot Springs, VA 24445
Medicare Provider Number
491300
Participating Start Date
1/1/2014
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tom Vandenhoven, CFO
(540) 839-7138
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2022
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