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WAL-MART PHARMACY 10-5997
DSH450352 Hunt Regional Medical Center
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Covered Entity Details
Entity Name
Hunt Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450352
Entity Address
4215 Joe Ramsey Blvd
Greenville, TX 75401
Medicare Provider Number
450352
Participating Start Date
1/1/2013
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/4/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lee Boles, CEO
(903) 408-1658
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/15/2019
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