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WALGREEN CO.
CAH291313-00 Banner Churchill Community Hospital
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Covered Entity Details
Entity Name
Banner Churchill Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH291313-00
Entity Address
801 East Williams Avenue
Fallon, NV 89406
Medicare Provider Number
291313
Participating Start Date
7/1/2016
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12488
1280 US HIGHWAY 95A N
FERNLEY, NV 89408
Pharmacy Comments
Contract Details
Approval Date
4/3/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven Fraker, Chief Financial Officer
(775) 867-7002
Contract Pharmacy Representative
Angie Juliana, 340B Implementation Analyst
(847) 964-4889
Signed By Date
4/3/2017
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