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WAL-MART PHARMACY 10-3269
CAH201306-00 RUMFORD HOSPITAL
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Covered Entity Details
Entity Name
RUMFORD HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201306-00
Entity Address
420 Franklin Street
RUMFORD, ME 04276
Medicare Provider Number
201306
Participating Start Date
8/31/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3269
Pharmacy Address
258 RIVER ROAD
MEXICO, ME 04257
Pharmacy Comments
Contract Details
Approval Date
11/28/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matthew Cox, CFO
(207) 795-0111
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/23/2012
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