340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-2006
CAH501332-00 TRI-STATE MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
TRI-STATE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501332-00
Entity Address
1221 HIGHLAND AVE
CLARKSTON, WA 99403
Medicare Provider Number
501332
Participating Start Date
9/30/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2006
Pharmacy Address
306 5TH STREET
CLARKSTON, WA 99403
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALEX TOWN, CFO
(509) 758-4667
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/14/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session