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WAL-MART PHARMACY 10-1871
CAH331318-00 Carthage Area Hospital, Inc.
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Covered Entity Details
Entity Name
Carthage Area Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331318-00
Entity Address
1001 West Street
Carthage, NY 13619
Medicare Provider Number
331318
Participating Start Date
1/1/2015
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1871
Pharmacy Address
20823 ST. - RT. #3
WATERTOWN, NY 13601
Pharmacy Comments
Contract Details
Approval Date
1/16/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rich Duvall, CEO
(315) 519-5201
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/16/2018
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