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WAL-MART PHARMACY 10-2794
CAH461306-00 GUNNISON VALLEY HOSPITAL
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Covered Entity Details
Entity Name
GUNNISON VALLEY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH461306-00
Entity Address
64 E 100 N
GUNNISON, UT 84634-0759
Medicare Provider Number
461306
Participating Start Date
9/30/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2794
Pharmacy Address
777 NO. MAIN STREET
EPHRAIM, UT 84627
Pharmacy Comments
Contract Details
Approval Date
5/11/2012
Contract Begin Date
5/11/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BRIAN C. MURRAY, CFO
(435) 528-2146
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/20/2012
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