Contract Pharmacy Details

WAL-MART PHARMACY 10-1593
RRC230022-01 COMMUNITY HEALTH CENTER BRANCH CTY

Covered Entity Details

Entity Name

COMMUNITY HEALTH CENTER BRANCH CTY

Subdivision Name

COMMUNITY HEALTH CENTER OF BRANCH / ONCOLOGY

Type

Rural Referral Center

340B ID

RRC230022-01

Entity Address

370 EAST CHICAGO STREET
COMMUNITY HEALTH CENTER ONCOLOGY
COLDWATER, MI 49036-2062

Medicare Provider Number

230022

Outpatient Facility Provider Number

Participating Start Date

7/1/2015

Last Recertification Date

11/9/2017

Entity Termination Date

4/1/2018

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-1593

Pharmacy Address

800 EAST CHICAGO STREET
COLDWATER, MI 49036

Pharmacy Comments

Contract Details

Approval Date

7/7/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Amy Crouch, CFO
(517) 279-5396

Contract Pharmacy Representative

Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719

Signed By Date

7/7/2015

340B Drug Pricing Program Database