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WAL-MART PHARMACY 10-0790
CAH281348-00 Cambridge Memorial Hospital Inc. DBA Tri Valley Health System
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Covered Entity Details
Entity Name
Cambridge Memorial Hospital Inc. DBA Tri Valley Health System
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281348-00
Entity Address
1305 West Hwy 6 & 34
Cambridge, NE 69022
Medicare Provider Number
281348
Participating Start Date
1/1/2014
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0790
Pharmacy Address
1902 WEST "B"
MCCOOK, NE 69001
Pharmacy Comments
Contract Details
Approval Date
4/4/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roger Steinkruger, CEO
(308) 697-1124
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/4/2014
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