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WAL-MART PHARMACY 10-1593
RRC230022-00 COMMUNITY HEALTH CENTER BRANCH CTY
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTER BRANCH CTY
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230022-00
Entity Address
274 EAST CHICAGO STREET
COLDWATER, MI 49036
Medicare Provider Number
230022
Participating Start Date
7/1/2015
Last Recertification Date
11/16/2017
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
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