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WAL-MART PHARMACY 10-1778
CAH531312-00 West Park Hospital District
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Covered Entity Details
Entity Name
West Park Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH531312-00
Entity Address
707 Sheridan Ave
Cody, WY 82414
Medicare Provider Number
531312
Participating Start Date
7/1/2012
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1778
Pharmacy Address
321 YELLOWSTONE AVENUE
CODY, WY 82414
Pharmacy Comments
Contract Details
Approval Date
10/7/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/2/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patrick McConnell, CFO
(307) 578-2490
Contract Pharmacy Representative
Angela Hamil, 340B Implementation Analyst
(479) 227-3719
Signed By Date
10/7/2015
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