340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH511316-00 GRANT MEMORIAL HOSPITAL, INC.
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Covered Entity Details
Entity Name
GRANT MEMORIAL HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511316-00
Entity Address
117 HOSPITAL DRIVE
PETERSBURG, WV 26847
Medicare Provider Number
511316
Participating Start Date
8/12/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/17/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John B Sylvia, President and CEO
(304) 257-1026 Ext: 5800
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/17/2024
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