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Walmart Pharmacy 10-7611
CAH501321-00 NORTH VALLEY HOSPITAL
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Covered Entity Details
Entity Name
NORTH VALLEY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501321-00
Entity Address
203 SOUTH WESTERN
TONASKET, WA 98855
Medicare Provider Number
501321
Participating Start Date
10/1/2019
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John McReynolds, CEO
(509) 486-3128
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/16/2023
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