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WAL-MART CENTRAL FILL 10-2670
CAH011305-00 St. Vincent's Blount
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Covered Entity Details
Entity Name
St. Vincent's Blount
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH011305-00
Entity Address
150 Gilbreath Drive
Oneonta, AL 35121
Medicare Provider Number
011305
Participating Start Date
1/1/2014
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregory Dale Brown, Administrator
(205) 274-3010
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/14/2017
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