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WAL-MART PHARMACY 10-2083
CHC06642-03 WESTERN MARYLAND HEALTH CARE CORPORATION
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Covered Entity Details
Entity Name
WESTERN MARYLAND HEALTH CARE CORPORATION
Subdivision Name
Mountain Laurel Medical Center Bruceton Mills
Type
HRSA-Funded Health Center
340B ID
CHC06642-03
Entity Address
198 Morgantown St
Ste 2
Bruceton Mills, WV 26525-5003
Grant Number
H80CS06642
Participating Start Date
10/1/2023
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2083
Pharmacy Address
75 RETAIL CIRCLE
MORGANTOWN, WV 26508
Pharmacy Comments
Contract Details
Approval Date
1/9/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James W. Mou, CFO
(301) 533-3300 Ext: 3018
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
1/9/2025
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