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WAL-MART PHARMACY 10-3514
CAH391313-00 CHARLES COLE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CHARLES COLE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391313-00
Entity Address
1001 EAST 2ND STREET
COUDERSPORT, PA 16915
Medicare Provider Number
391313
Participating Start Date
8/25/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3514
Pharmacy Address
50 FOSTER BROOK BLVD
BRADFORD, PA 16701
Pharmacy Comments
Contract Details
Approval Date
1/3/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
EDWARD C PITCHFORD, PRESIDENT & CEO
(814) 260-5216
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/3/2014
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