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WALMART PHARMACY 10-5169
CAH331320-00 Bassett Hospital of Schoharie County dba Cobleskill Regional Hospital
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Covered Entity Details
Entity Name
Bassett Hospital of Schoharie County dba Cobleskill Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331320-00
Entity Address
178 Grandview Drive
Cobleskill, NY 12043
Medicare Provider Number
331320
Participating Start Date
10/1/2019
Last Recertification Date
8/29/2024
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
4/21/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Guy DiStefano, VP of Financial Operations
(607) 547-3692
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/21/2023
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