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WAL-MART PHARMACY 10-5497
CAH331318-00 Carthage Area Hospital, Inc.
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Covered Entity Details
Entity Name
Carthage Area Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331318-00
Entity Address
1001 West Street
Carthage, NY 13619
Medicare Provider Number
331318
Participating Start Date
1/1/2015
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5497
Pharmacy Address
25737 US ROUTE #11
EVANS MILLS, NY 13637
Pharmacy Comments
Contract Details
Approval Date
1/6/2015
Contract Begin Date
1/7/2015
Carve-In Effective Date
Contract Comments
1/7/15-Immediate contract begin date authorized.
Contacts
Covered Entity Signing Official
Rich Duvall, CEO
(315) 519-5201
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/6/2015
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