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WAL-MART PHARMACY 10-0626
CAH451358-00 MEMORIAL HOSPITAL-SEMINOLE
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL-SEMINOLE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451358-00
Entity Address
209 NORTHWEST 8TH STREET
SEMINOLE, TX 79360-3499
Medicare Provider Number
451358
Participating Start Date
4/1/2019
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0626
Pharmacy Address
2000 HOBBS HIGHWAY
P.O. BOX 1807
SEMINOLE, TX 79360
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/9/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James Gordon Parrish, CEO
(432) 758-4814
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/16/2017
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