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Walmart Pharmacy 10-7611
CAH491302-00 CARILION GILES COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
CARILION GILES COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491302-00
Entity Address
159 HARTLEY WAY
PEARISBURG, VA 24134
Medicare Provider Number
491302
Participating Start Date
8/30/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/9/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tim Auwarter, VP Hospital Operations
(540) 981-7804
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/9/2024
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