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WAL-MART PHARMACY 10-0696
DSH180078 ARH TUG VALLEY HEALTH SERVICES, INC. DBA PAINTSVILLE ARH HOSPITAL
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Covered Entity Details
Entity Name
ARH TUG VALLEY HEALTH SERVICES, INC. DBA PAINTSVILLE ARH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180078
Entity Address
625 James Trimble Blvd
PAINTSVILLE, KY 41240
Medicare Provider Number
180078
Participating Start Date
2/22/2022
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0696
Pharmacy Address
477 VILLAGE DRIVE
PRESTONBURG, KY 41653
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hollie P Harris, President & CEO
(859) 226-2511
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/15/2022
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