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Walmart Pharmacy 10-7611
CAH501304-00 Grays Harbor County Public Hospital District No. 1 DBA Summit Pacific Medical Center
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Covered Entity Details
Entity Name
Grays Harbor County Public Hospital District No. 1 DBA Summit Pacific Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501304-00
Entity Address
600 East Main St
Elma, WA 98541
Medicare Provider Number
501304
Participating Start Date
1/1/2015
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Josh Martin, CEO
(360) 346-2244
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/4/2023
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