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WALMART PHARMACY 10-3614
CAH491304-00 CARILION ROCKBRIDGE COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
CARILION ROCKBRIDGE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491304-00
Entity Address
1 HEALTH CIRCLE
LEXINGTON, VA 24450
Medicare Provider Number
491304
Participating Start Date
8/30/2010
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-3614
Pharmacy Address
2141 DALE AVE
ROANOKE, VA 24013
Pharmacy Comments
Contract Details
Approval Date
7/13/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/5/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Greg Todd Madsen, VP
(540) 458-3590
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/13/2022
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