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WAL-MART PHARMACY 10-2143
CAH201314-00 REDINGTON-FAIRVIEW GENERAL HOSPITAL
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Covered Entity Details
Entity Name
REDINGTON-FAIRVIEW GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201314-00
Entity Address
46 FAIRVIEW AVE
SKOWHEGAN, ME 04976
Medicare Provider Number
201314
Participating Start Date
4/1/2011
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2143
Pharmacy Address
60 FAIRGROUNDS MARKET PLACE
SKOWHEGAN, ME 04976
Pharmacy Comments
Contract Details
Approval Date
10/9/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LISA CASWELL, DIRECTOR OF PHARMACY
(207) 858-8785
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/9/2014
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