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WAL-MART PHARMACY 10-4697
SCH490021-00 CENTRA HEALTH
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Covered Entity Details
Entity Name
CENTRA HEALTH
Subdivision Name
Lynchburg General Hospital
Type
Sole Community Hospital
340B ID
SCH490021-00
Entity Address
1920 ATHERHOLT ROAD
LYNCHBURG, VA 24501
Medicare Provider Number
490021
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4697
Pharmacy Address
3227 OLD FOREST ROAD
LYNCHBURG, VA 24501
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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