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WAL-MART PHARMACY 10-1350
SCH490021-00 CENTRA HEALTH, INC
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Covered Entity Details
Entity Name
CENTRA HEALTH, INC
Subdivision Name
Lynchburg General Hospital
Type
Sole Community Hospital
340B ID
SCH490021-00
Entity Address
1901 TATE SPRINGS RD
LYNCHBURG, VA 24501
Medicare Provider Number
490021
Participating Start Date
4/1/2011
Last Recertification Date
8/31/2022
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1350
Pharmacy Address
3900 WARDS RD
LYNCHBURG, VA 24502
Pharmacy Comments
Contract Details
Approval Date
1/10/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DAVID G. GOUGH, CFO
(434) 200-4712
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/10/2018
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