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WAL-MART PHARMACY 10-1058
SCH060006-00 MONTROSE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MONTROSE MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH060006-00
Entity Address
800 S Third Street
MONTROSE, CO 81401
Medicare Provider Number
060006
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1058
Pharmacy Address
16750 S. TOWNSEND
MONTROSE, CO 81401
Pharmacy Comments
Contract Details
Approval Date
1/19/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mary Snyder, COO
(970) 240-7398
Contract Pharmacy Representative
Robin Howe, pharmacy manager
(970) 249-7742
Signed By Date
1/19/2015
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