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WAL-MART PHARMACY #10-2474
CH031600 TRI-STATE COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
TRI-STATE COMMUNITY HEALTH CENTER
Subdivision Name
TRI-STATE COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH031600
Entity Address
130 W High St
Hancock, MD 21750-1143
Grant Number
H80CS00069
Participating Start Date
12/1/1992
Last Recertification Date
3/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY #10-2474
Pharmacy Address
R.R. #4 BOX 82
KEYSER, WV 26726
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SHEILA DESHONG, COO
(301) 678-5187 Ext: 226
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/15/2018
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