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WAL-MART PHARMACY 10-2400
DSH360159 ADENA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ADENA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360159
Entity Address
272 HOSPITAL ROAD
CHILLICOTHE, OH 45601
Medicare Provider Number
360159
Participating Start Date
4/1/2008
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2400
Pharmacy Address
85 RIVER TRACE LANE
CHILLICOTHE, OH 45601
Pharmacy Comments
Contract Details
Approval Date
4/21/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert M. Rosenberger, CFO
(740) 779-7582
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/21/2016
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