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WAL-MART PHARMACY 10-1328
CAH031311-00 Winslow Memorial Hospital dba Little Colorado Medical Center
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Covered Entity Details
Entity Name
Winslow Memorial Hospital dba Little Colorado Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031311-00
Entity Address
1501 N WILLIAMSON AVENUE
WINSLOW, AZ 86047
Medicare Provider Number
031311
Participating Start Date
7/1/2013
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1328
Pharmacy Address
700 MIKE'S PIKE ST
WINSLOW, AZ 86047
Pharmacy Comments
Contract Details
Approval Date
4/13/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ross Black, COO
(928) 289-6345
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/13/2016
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