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WAL-MART PHARMACY 10-1593
DSH230022 COMMUNITY HEALTH CENTER BRANCH CTY
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTER BRANCH CTY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230022
Entity Address
274 EAST CHICAGO STREET
COLDWATER, MI 49036
Medicare Provider Number
230022
Participating Start Date
4/1/2018
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1593
Pharmacy Address
800 EAST CHICAGO STREET
COLDWATER, MI 49036
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Randy DeGroot, CEO
(517) 279-5489
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/12/2018
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