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WAL-MART PHARMACY #10-2474
CHC06642-02 Western Maryland Health Care Corporation
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Covered Entity Details
Entity Name
Western Maryland Health Care Corporation
Subdivision Name
Mountain Laurel Medical Center Westernport
Type
HRSA-Funded Health Center
340B ID
CHC06642-02
Entity Address
22221 Westernport Rd SW
Westernport, MD 21562-2206
Grant Number
H80CS06642
Participating Start Date
1/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY #10-2474
Pharmacy Address
R.R. #4 BOX 82
KEYSER, WV 26726
Pharmacy Comments
Contract Details
Approval Date
7/6/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRIAN BAILEY, CEO
(301) 533-3300 Ext: 3056
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/6/2023
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