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WAL-MART PHARMACY 10-1063
CAH101307-00 Holmes County Hospital Corp d/b/a Doctors Memorial Hospital
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Covered Entity Details
Entity Name
Holmes County Hospital Corp d/b/a Doctors Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH101307-00
Entity Address
2600 Hospital Drive
Bonifay, FL 32425-4264
Medicare Provider Number
101307
Participating Start Date
1/1/2014
Last Recertification Date
9/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1063
Pharmacy Address
1608 W MAGNOLIA AVE
GENEVA, AL 36340
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/5/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JoAnn Baker, Administrator
(850) 547-8001
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/12/2017
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