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WAL-MART PHARMACY 10-5315
DSH360211 TRINITY HOSPITAL HOLDING COMPANY
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Covered Entity Details
Entity Name
TRINITY HOSPITAL HOLDING COMPANY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360211
Entity Address
4000 JOHNSON ROAD
STEUBENVILLE, OH 43952
Medicare Provider Number
360211
Participating Start Date
4/1/2022
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/13/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Dave Werkin, CFO
(740) 264-8695
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/13/2018
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