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WAL-MART PHARMACY 10-2484
CAH101309-00 Hendry County Hospital Authority DBA Hendry Regional Medical Center
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Covered Entity Details
Entity Name
Hendry County Hospital Authority DBA Hendry Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH101309-00
Entity Address
524 W Sagamore Ave
Clewiston, FL 33440
Medicare Provider Number
101309
Participating Start Date
4/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2484
Pharmacy Address
1005 WEST SUGARLAND HWY
CLEWISTON, FL 33440
Pharmacy Comments
Contract Details
Approval Date
4/9/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Beltz, CFO
(863) 902-3082
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/9/2014
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