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WALMART PHARMACY 10-4203
CAH051323-00 Colorado River Medical Center
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Covered Entity Details
Entity Name
Colorado River Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051323-00
Entity Address
1401 Bailey Avenue
Needles, CA 92363
Medicare Provider Number
051323
Participating Start Date
4/1/2014
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4203
Pharmacy Address
5210 S. HIGHWAY 95
FORT MOHAVE, AZ 86426-7271
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
8/29/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bing Lum, Executive Vice-President
(760) 326-7162
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/16/2018
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