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WALMART PHARMACY 10-6207
RRC230130-00 WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak
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Covered Entity Details
Entity Name
WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230130-00
Entity Address
3601 WEST 13 MILE ROAD
ROYAL OAK, MI 48073-6769
Medicare Provider Number
230130
Participating Start Date
4/1/2017
Last Recertification Date
8/30/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-6207
Pharmacy Address
14344 SPRING HILL DRIVE
SPRING HILL, FL 34609
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Carolyn Wilson, Chief Operating Officer
(947) 522-3338
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/14/2019
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