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WALMART PHARMACY 10-5169
CAH511321-00 ST. JOSEPHS HOSPITAL
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Covered Entity Details
Entity Name
ST. JOSEPHS HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511321-00
Entity Address
1 AMALIA DRIVE
BUCKHANNON, WV 26201
Medicare Provider Number
511321
Participating Start Date
10/1/2015
Last Recertification Date
8/16/2024
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
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Russell J. Plywaczynski, Director of Finance
(304) 460-7955
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/17/2023
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