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WAL-MART PHARMACY 10-2115
CAH361302-00 TRINITY HOSPITAL TWIN CITY
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Covered Entity Details
Entity Name
TRINITY HOSPITAL TWIN CITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361302-00
Entity Address
819 N 1st STREET
DENNISON, OH 44621-1003
Medicare Provider Number
361302
Participating Start Date
7/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2115
Pharmacy Address
231 BLUEBELL DR NW.
NEW PHILADELPHIA, OH 44663
Pharmacy Comments
Contract Details
Approval Date
1/7/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
WOODROW W. HATHAWAY JR., CHIEF FINANCIAL OFFICER
(740) 922-7450 Ext: 2190
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/7/2014
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