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WAL-MART PHARMACY 10-3260
CAH501320-00 QUINCY VALLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
QUINCY VALLEY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501320-00
Entity Address
908 10TH AVENUE SW
QUINCY, WA 98848
Medicare Provider Number
501320
Participating Start Date
4/1/2017
Last Recertification Date
11/17/2017
Entity Termination Date
10/1/2018
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3260
Pharmacy Address
1399 NAT WASHINGTON WAY
EPHRATA, WA 98823
Pharmacy Comments
Contract Details
Approval Date
4/22/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Contacts
Covered Entity Signing Official
Mehdi Merred, CEO
(509) 787-5346
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/22/2013
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