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WAL-MART PHARMACY 10-5315
CAH391308-00 CORRY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CORRY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391308-00
Entity Address
965 SHAMROCK LANE
CORRY, PA 16407
Medicare Provider Number
391308
Participating Start Date
7/1/2015
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/23/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Heller, Chief Financial Officer
(814) 664-4641 Ext: 1040
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/16/2018
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