340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-2909

Pharmacy Address

961 ROUTE 6
CORRY, PA 16407

Pharmacy Comments

Approval Date

6/25/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Michael Heller, Chief Financial Officer
(814) 664-4641 Ext: 1040

Contract Pharmacy Representative

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

Signed By Date

6/25/2015