340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-5315
CAH331321-00 ALICE HYDE MEDICAL CENTER
Print
Covered Entity Details
Entity Name
ALICE HYDE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331321-00
Entity Address
133 PARK STREET
MALONE, NY 12953
Medicare Provider Number
331321
Participating Start Date
11/27/2023
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
11/27/2023
Contract Begin Date
11/27/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matej Kollar, Vice President/Chief Financial Officer
(518) 481-8065
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
11/21/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session