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WALMART PHARMACY 10-5169
CAH501334-00 LAKE CHELAN COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
LAKE CHELAN COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501334-00
Entity Address
110 S Apple Blossom Dr.
CHELAN, WA 98816
Medicare Provider Number
501334
Participating Start Date
1/1/2016
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
1/9/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Aaron Christopher Edwards, CEO
(509) 682-8503
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/9/2023
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