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WAL-MART PHARMACY 10-2143
CAH471306-00 SPRINGFIELD HOSPITAL
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Covered Entity Details
Entity Name
SPRINGFIELD HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471306-00
Entity Address
25 RIDGEWOOD ROAD
SPRINGFIELD, VT 05156
Medicare Provider Number
471306
Participating Start Date
1/1/2011
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2143
Pharmacy Address
60 FAIRGROUNDS MARKET PLACE
SKOWHEGAN, ME 04976
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lester G. Peck, Director of Pharmacy
(802) 885-7571
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/17/2023
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