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WAL-MART PHARMACY 10-4474
SCH020024-00 CENTRAL PENINSULA HOSPITAL
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Covered Entity Details
Entity Name
CENTRAL PENINSULA HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH020024-00
Entity Address
250 HOSPITAL PLACE
SOLDOTNA, AK 99669
Medicare Provider Number
020024
Participating Start Date
4/1/2017
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4474
Pharmacy Address
10096 KENAI SPUR HWY
KENAI, AK 99611
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angela Hinnegan, Assistant Controller
(907) 714-4526
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/17/2017
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