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WAL-MART PHARMACY 10-2968
CAH181310-00 CARROLL COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CARROLL COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181310-00
Entity Address
309 11TH STREET
CARROLLTON, KY 41008
Medicare Provider Number
181310
Participating Start Date
10/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2968
Pharmacy Address
200 FLOYD DRIVE
CARROLLTON, KY 41008
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael A. Kozar, CEO
(502) 732-3200
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/15/2015
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