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WALMART PHARMACY 10-5169
CAH511322-00 West Virginia Health Care Cooperative, Inc. DBA Summersville Regional Medical Center
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Covered Entity Details
Entity Name
West Virginia Health Care Cooperative, Inc. DBA Summersville Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511322-00
Entity Address
400 FAIRVIEW HEIGHTS ROAD
SUMMERSVILLE, WV 26651
Medicare Provider Number
511322
Participating Start Date
7/1/2019
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
4/4/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Timothy Lewis, COO
(304) 872-2891
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/4/2023
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