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WAL-MART PHARMACY 10-2351
RRC330094-00 Columbia Memorial Hospital
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Covered Entity Details
Entity Name
Columbia Memorial Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330094-00
Entity Address
71 Prospect Aveune
Hudson, NY 12534
Medicare Provider Number
330094
Participating Start Date
10/1/2013
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2351
Pharmacy Address
30 CATSKILL COMMONS
CATSKILL, NY 12414
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bryan T. Mahoney, Chief Financial Officer
(518) 697-3230
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/15/2016
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