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WAL-MART PHARMACY 10-5997
CAH031302-00 NORTHERN COCHISE COMMUNITY HOSPITAL, INC.
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Covered Entity Details
Entity Name
NORTHERN COCHISE COMMUNITY HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031302-00
Entity Address
901 WEST REX ALLEN DRIVE
WILLCOX, AZ 85643
Medicare Provider Number
031302
Participating Start Date
8/5/2010
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
4/4/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roland Knox, CHIEF EXECUTIVE OFFICER
(520) 766-6465
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/4/2017
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