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WAL-MART PHARMACY 10-1095
CAH061325-00 PIONEERS MEDICAL CENTER
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Covered Entity Details
Entity Name
PIONEERS MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061325-00
Entity Address
100 PIONEERS MEDICAL CENTER DRIVE
MEEKER, CO 81641
Medicare Provider Number
061325
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1095
Pharmacy Address
3010 BLAKE AVENUE
GLENWOOD SPRINGS, CO 81601
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kenneth Lee Harman, CEO
(970) 878-9260
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/12/2018
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