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WAL-MART PHARMACY #10-0519
CAH181302-00 JAMES B HAGGIN MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
JAMES B HAGGIN MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181302-00
Entity Address
464 LINDEN AVENUE
HARRODSBURG, KY 40330
Medicare Provider Number
181302
Participating Start Date
1/1/2016
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY #10-0519
Pharmacy Address
591 JOSEPH DRIVE
HARRODSBURG, KY 40330
Pharmacy Comments
Contract Details
Approval Date
1/21/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Victoria L. Reed, Chief Executive Officer
(859) 733-4801
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/21/2016
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