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WAL-MART PHARMACY 10-0034
DSH260061 NEVADA CITY HOSPITAL
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Covered Entity Details
Entity Name
NEVADA CITY HOSPITAL
Subdivision Name
DBA NEVADA REGIONAL MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH260061
Entity Address
800 SOUTH ASH STREET
NEVADA, MO 64772
Medicare Provider Number
260061
Participating Start Date
7/1/2009
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0034
Pharmacy Address
2250 LINCOLN AVE
NEVADA, MO 64772
Pharmacy Comments
Contract Details
Approval Date
7/14/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Leeper, CEO
(417) 448-3626
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/14/2015
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