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WAL-MART PHARMACY 10-0702
DSH180018 ST CLAIRE MEDICAL CENTER INC
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Covered Entity Details
Entity Name
ST CLAIRE MEDICAL CENTER INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180018
Entity Address
222 MEDICAL CIRCLE
MOREHEAD, KY 40351
Medicare Provider Number
180018
Participating Start Date
1/1/2005
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0702
Pharmacy Address
1859 BYPASS ROAD
WINCHESTER, KY 40391
Pharmacy Comments
Contract Details
Approval Date
4/10/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/17/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Chris McClurg, VP FINANCIAL SERVICES/CFO
(606) 783-6587
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/10/2017
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