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WAL-MART PHARMACY 10-1974
CAH201308-00 HOULTON REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
HOULTON REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201308-00
Entity Address
20 HARTFORD STREET
HOULTON, ME 04730
Medicare Provider Number
201308
Participating Start Date
9/15/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1974
Pharmacy Address
17 LUDLOW ROAD
HOULTON, ME 04730
Pharmacy Comments
Contract Details
Approval Date
7/15/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CYNTHIA THOMPSON, CFO
(207) 532-2900 Ext: 2142
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/15/2014
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