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WAL-MART PHARMACY 10-2047
CAH201313-00 Sebasticook Valley Health
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Covered Entity Details
Entity Name
Sebasticook Valley Health
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201313-00
Entity Address
447 NORTH MAIN STREET
PITTSFIELD, ME 04967
Medicare Provider Number
201313
Participating Start Date
7/1/2011
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2047
Pharmacy Address
1573 MAIN STREET
PALMYRA, ME 04965
Pharmacy Comments
Contract Details
Approval Date
4/18/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RANDALL CLARK, PRESIDENT
(207) 487-4022
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/18/2014
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