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WAL-MART PHARMACY 10-2681
CAH301303-01 WEEKS MEDICAL CENTER
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Covered Entity Details
Entity Name
WEEKS MEDICAL CENTER
Subdivision Name
WEEKS MEDICAL CENTER-SWING BED
Type
Critical Access Hospital
340B ID
CAH301303-01
Entity Address
173 MIDDLE STREET
LANCASTER, NH 03584
Medicare Provider Number
301303
Outpatient Facility Provider Number
Participating Start Date
9/24/2010
Last Recertification Date
8/10/2015
Entity Termination Date
4/1/2016
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2681
Pharmacy Address
615 MEADOW STREET
LITTLETON, NH 03561
Pharmacy Comments
Contract Details
Approval Date
10/13/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Contacts
Covered Entity Signing Official
CELESTE PITTS, Vice President of Finance
(603) 788-5321
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/13/2014
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