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WAL-MART PHARMACY 10-2039
CAH051304-00 JOHN C. FREMONT HEALTHCARE DISTRICT
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Covered Entity Details
Entity Name
JOHN C. FREMONT HEALTHCARE DISTRICT
Subdivision Name
A POLITICAL SUBDIVISION OF THE STATE OF CALIFORNIA
Type
Critical Access Hospital
340B ID
CAH051304-00
Entity Address
5189 HOSPITAL RD
MARIPOSA, CA 95338-0216
Medicare Provider Number
051304
Participating Start Date
1/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2039
Pharmacy Address
3055 LOUGHBOROUGH DRIVE
MERCED, CA 95348
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/19/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ALAN MACPHEE, CHIEF EXECUTIVE OFFICER
(209) 966-3631 Ext: 290
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/15/2015
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