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WAL-MART CENTRAL FILL 10-2670
CAH391308-00 CORRY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CORRY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391308-00
Entity Address
965 SHAMROCK LANE
CORRY, PA 16407
Medicare Provider Number
391308
Participating Start Date
7/1/2015
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
1/11/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Heller, Chief Financial Officer
(814) 664-4641 Ext: 1040
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/11/2017
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