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WAL-MART PHARMACY 10-2244
DSH510055 Cabell Huntington Hospital, Inc.
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Covered Entity Details
Entity Name
Cabell Huntington Hospital, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510055
Entity Address
1340 Hal Greer Blvd.
Huntington, WV 25701-0195
Medicare Provider Number
510055
Participating Start Date
4/1/2005
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2244
Pharmacy Address
3333 US ROUTE 60
HUNTINGTON, WV 25705
Pharmacy Comments
Contract Details
Approval Date
4/2/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David M. Ward, SENIOR VP AND CfO
(304) 526-2274
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/2/2015
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