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WALMART PHARMACY 10-5169
CAH331302-00 ELIZABETHTOWN COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
ELIZABETHTOWN COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331302-00
Entity Address
75 PARK STREET
ELIZABETHTOWN, NY 12932
Medicare Provider Number
331302
Participating Start Date
9/30/2010
Last Recertification Date
8/23/2024
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
1/12/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/20/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Scott Alan Comeau, CFO
(802) 388-4752
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/12/2023
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