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WAL-MART PHARMACY 10-3632
CAH231314-00 McKenzie Memorial Hospital
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Covered Entity Details
Entity Name
McKenzie Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231314-00
Entity Address
120 Delaware Street
Sandusky, MI 48471
Medicare Provider Number
231314
Participating Start Date
7/1/2013
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3632
Pharmacy Address
655 WEST SANILAC ROAD
SANDUSKY, MI 48471
Pharmacy Comments
Contract Details
Approval Date
10/13/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Amy Ruedisueli, CFO
(810) 648-6162
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/13/2014
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