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WAL-MART PHARMACY 10-2159
RRC330103-00 Olean General Hospital
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Covered Entity Details
Entity Name
Olean General Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330103-00
Entity Address
515 Main Street
Olean, NY 14760
Medicare Provider Number
330103
Participating Start Date
4/1/2014
Last Recertification Date
8/23/2018
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2159
Pharmacy Address
RTE 417
1869 PLAZA DR
OLEAN, NY 14760
Pharmacy Comments
Contract Details
Approval Date
1/12/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard G. Braun Jr., SVP Finance and CFO
(716) 375-6190
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/12/2015
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