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WAL-MART PHARMACY 10-2036
DSH510022 CHARLESTON AREA MEDICAL CENTER (CAMC)
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Covered Entity Details
Entity Name
CHARLESTON AREA MEDICAL CENTER (CAMC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510022
Entity Address
501 MORRIS STREET
CHARLESTON, WV 25301
Medicare Provider Number
510022
Participating Start Date
9/22/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2036
Pharmacy Address
2700 MOUNTAINEER BLVD
SOUTH CHARLESTON, WV 25309
Pharmacy Comments
Contract Details
Approval Date
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LARRY HUDSON, EXECUTIVE VICE PRESIDENT AND CFO
(304) 388-7603
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/15/2016
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