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WAL-MART PHARMACY 10-5315
CAH051321-00 NorCal HealthConnect LLC- DBA Healdsburg Hospital
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Covered Entity Details
Entity Name
NorCal HealthConnect LLC- DBA Healdsburg Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051321-00
Entity Address
1375 UNIVERSITY AVENUE
HEALDSBURG, CA 95448
Medicare Provider Number
051321
Participating Start Date
8/23/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
11/10/2017
Contract Begin Date
11/14/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/26/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Berta Beadel Kaemmerling, Chief Nursing Officer
(707) 431-6327
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
11/10/2017
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