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WAL-MART PHARMACY 10-5315
CAH511300-00 Broaddus Hospital Association, Inc. DBA Broaddus Hospital
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Covered Entity Details
Entity Name
Broaddus Hospital Association, Inc. DBA Broaddus Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511300-00
Entity Address
# 1 HEALTHCARE DRIVE
PHILIPPI, WV 26416
Medicare Provider Number
511300
Participating Start Date
10/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
4/22/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DANA GOULD, CEO
(304) 457-8155
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
4/22/2024
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