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WAL-MART PHARMACY 10-1259
DSH180011 SAINT JOSEPH HEALTH SYSTEM
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Covered Entity Details
Entity Name
SAINT JOSEPH HEALTH SYSTEM
Subdivision Name
DBA SAINT JOSEPH - LONDON
Type
Disproportionate Share Hospital
340B ID
DSH180011
Entity Address
1001 SAINT JOSEPH LANE
LONDON, KY 40741
Medicare Provider Number
180011
Participating Start Date
4/1/2006
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1259
Pharmacy Address
60 SOUTH STEWART ROAD
CORBIN, KY 40701
Pharmacy Comments
Contract Details
Approval Date
10/14/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christy Spitser, Vice President of Finance
(606) 330-6016
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/14/2018
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