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WAL-MART PHARMACY 10-1033
DSH150065 SCHNECK MEDICAL CENTER
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Covered Entity Details
Entity Name
SCHNECK MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150065
Entity Address
411 WEST TIPTON STREET
SEYMOUR, IN 47274
Medicare Provider Number
150065
Participating Start Date
10/1/2016
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1033
Pharmacy Address
1600 E TIPTON ST
SEYMOUR, IN 47274
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deborah Ridlen, VP Finance/CFO
(812) 522-0170
Contract Pharmacy Representative
Wal-mart
Laura Levine, Manager Contracting
(479) 204-8550
Signed By Date
7/16/2018
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