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Walmart Pharmacy 10-7611
CAH301308-00 VALLEY REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
VALLEY REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301308-00
Entity Address
243 ELM STREET
CLAREMONT, NH 03743
Medicare Provider Number
301308
Participating Start Date
4/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jocelyn Caple, Chief Executive Officer
(603) 542-3454
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/12/2024
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