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LANTZ'S PHARMACY
CAH491305-00 SHENANDOAH MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SHENANDOAH MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491305-00
Entity Address
759 SOUTH MAIN STREET
WOODSTOCK, VA 22664
Medicare Provider Number
491305
Participating Start Date
9/27/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
LANTZ'S PHARMACY
Pharmacy Address
5015 MAIN STREET
STEPHENS CITY, VA 22655
Pharmacy Comments
Contract Details
Approval Date
12/6/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2017
Ownership change
Contacts
Covered Entity Signing Official
VIRGINIA KILMER, CFO
(540) 459-1120
Contract Pharmacy Representative
Keith Lantz, Owner
(540) 459-5300
Signed By Date
10/15/2012
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