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WALMART PHARMACY 10-5169
SCH020024-00 CENTRAL PENINSULA HOSPITAL
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Covered Entity Details
Entity Name
CENTRAL PENINSULA HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH020024-00
Entity Address
250 HOSPITAL PLACE
SOLDOTNA, AK 99669
Medicare Provider Number
020024
Participating Start Date
4/1/2017
Last Recertification Date
9/5/2024
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
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shaun Patrick Keef, Chief Executive Officer
(907) 714-4719
Contract Pharmacy Representative
Central Peninsula Hospital
Amy Beth Kauffman, Pharmacy Director
(907) 714-4795
Signed By Date
4/14/2023
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