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WAL-MART PHARMACY 10-2060
DSH180143 SAINT JOSEPH EAST
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Covered Entity Details
Entity Name
SAINT JOSEPH EAST
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180143
Entity Address
150 NORTH EAGLE CREEK DRIVE
LEXINGTON, KY 40509
Medicare Provider Number
180143
Participating Start Date
1/1/2008
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2060
Pharmacy Address
3180 RICHMOND ROAD
LEXINGTON, KY 40509
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/9/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Eric Gilliam, President
(859) 967-5750
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2018
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