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WAL-MART PHARMACY 10-1382
CAH421301-00 ABBEVILLE COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ABBEVILLE COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH421301-00
Entity Address
420 THOMSON CIRCLE
ABBEVILLE, SC 29620
Medicare Provider Number
421301
Participating Start Date
8/19/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1382
Pharmacy Address
508 BYPASS 72 NW
GREENWOOD, SC 29649
Pharmacy Comments
Contract Details
Approval Date
2/11/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TIMOTHY WREN, CFO
(864) 366-3310
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/16/2013
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