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EXPRESS SCRIPTS PHARMACY, INC.
CAH031315-00 WHITE MOUNTAIN REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
WHITE MOUNTAIN REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031315-00
Entity Address
118 SOUTH MOUNTAIN AVE
SPRINGERVILLE, AZ 85938
Medicare Provider Number
031315
Participating Start Date
4/1/2017
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
EXPRESS SCRIPTS PHARMACY, INC.
Pharmacy Address
DBA EXPRESS SCRIPTS
4750 E. 450 S.
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
4/18/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wesley Babers, CEO
(928) 333-7178
Contract Pharmacy Representative
Accredo
Diana Florio, 340B Managing Director
(407) 988-7044
Signed By Date
4/18/2025
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