340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-2484
CAH101309-02 Hendry County Hospital Authority DBA Hendry Regional Medical Center
Print
Covered Entity Details
Entity Name
Hendry County Hospital Authority DBA Hendry Regional Medical Center
Subdivision Name
Hendry Regional Convenient Care Center
Type
Critical Access Hospital
340B ID
CAH101309-02
Entity Address
450 S. Main St Suite 1
Labelle, FL 33935
Medicare Provider Number
101309
Outpatient Facility Provider Number
103445
Participating Start Date
4/1/2014
Last Recertification Date
8/12/2024
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
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session