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BI RITE PROFESSIONAL PHARMACY
CAH531316-00 Memorial Hospital of Carbon County
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Covered Entity Details
Entity Name
Memorial Hospital of Carbon County
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH531316-00
Entity Address
2221 W. Elm St.
Rawlins, WY 82301-0460
Medicare Provider Number
531316
Participating Start Date
1/1/2012
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
BI RITE PROFESSIONAL PHARMACY
Pharmacy Address
300 3RD STREET
RAWLINS, WY 82301
Pharmacy Comments
Contract Details
Approval Date
7/9/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/19/2015
Pharmacy closed
Contacts
Covered Entity Signing Official
Amber Green, CCO
(307) 324-8212
Contract Pharmacy Representative
Rod Waeckerlin, Pharmacist
(307) 324-3403
Signed By Date
7/9/2014
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