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WAL-MART PHARMACY 10-5315
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 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/14/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/9/2020
Business decision by covered entity and/or pharmacy
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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