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WAL-MART PHARMACY 10-2319
CAH501339-00 WHIDBEY GENERAL HOSPITAL
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Covered Entity Details
Entity Name
WHIDBEY GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501339-00
Entity Address
101 N MAIN ST
Inpatient Pharmacy
COUPEVILLE, WA 98239
Medicare Provider Number
501339
Participating Start Date
10/1/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2319
Pharmacy Address
1250 S.W. ERIE STREET
OAK HARBOR, WA 98277
Pharmacy Comments
Contract Details
Approval Date
8/20/2012
Contract Begin Date
8/20/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Hank Hanigan, COO
(360) 678-7656 Ext: 4007
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/31/2012
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