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ADVENTIST HEALTH COMMUNITY PHARMACY
DSH500049 WALLA WALLA GENERAL HOSPITAL
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Covered Entity Details
Entity Name
WALLA WALLA GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500049
Entity Address
1025 SOUTH SECOND AVE.
WALLA WALLA, WA 99362
Medicare Provider Number
500049
Participating Start Date
7/1/2006
Last Recertification Date
8/30/2016
Entity Termination Date
10/1/2017
Pharmacy Details
Pharmacy Name
ADVENTIST HEALTH COMMUNITY PHARMACY
Pharmacy Address
WALLA WALLA GENERAL HOSPITAL
1111 S. 2ND AVE
WALLA WALLA, WA 99362
Pharmacy Comments
Contract Details
Approval Date
5/7/2012
Contract Begin Date
5/7/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2017
Contacts
Covered Entity Signing Official
Greg McCulloch, President
(209) 536-5012
Contract Pharmacy Representative
Adventist Health Pharmacy
Geoff Jones, Director of Pharmacy
(509) 527-8268
Signed By Date
5/1/2012
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