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WAL-MART PHARMACY 10-5315
DSH340075 Blue Ridge HealthCare Hospitals, Inc
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Covered Entity Details
Entity Name
Blue Ridge HealthCare Hospitals, Inc
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340075
Entity Address
2201 SOUTH STERLING STREET
MORGANTON, NC 28655
Medicare Provider Number
340075
Participating Start Date
12/6/2005
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/3/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
KATHY BAILEY, CEO
(828) 580-5586
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/3/2018
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