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WAL-MART PHARMACY 10-5470
CAH391303-00 FULTON COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
FULTON COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391303-00
Entity Address
214 PEACH ORCHARD ROAD
MCCONNELLSBURG, PA 17233
Medicare Provider Number
391303
Participating Start Date
4/1/2015
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5470
Pharmacy Address
6716 TOWN CENTER BLVD
HUNTINGDON, PA 16652
Pharmacy Comments
Contract Details
Approval Date
7/17/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/17/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Makosky, CEO
(717) 485-3155
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/17/2024
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