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WAL-MART PHARMACY 10-2259
SCH270051-00 KALISPELL REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
KALISPELL REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH270051-00
Entity Address
310 SUNNYVIEW LANE
KALISPELL, MT 59901
Medicare Provider Number
270051
Participating Start Date
9/24/2010
Last Recertification Date
9/11/2020
Entity Termination Date
1/1/2021
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2259
Pharmacy Address
170 HUTTON RANCH ROAD
KALISPELL, MT 59901
Pharmacy Comments
Contract Details
Approval Date
10/9/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
CHARLES PEARCE, C.F.I.O.
(406) 752-1724
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/9/2015
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