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WALMART PHARMACY #10-4471
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
WALMART PHARMACY #10-4471
Pharmacy Address
2390 E. CEDAR
RAWLINS, WY 82301
Pharmacy Comments
Contract Details
Approval Date
4/8/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Amber Green, CCO
(307) 324-8212
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/8/2015
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