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WAL-MART PHARMACY 10-3522
DSH050238 USC ARCADIA HOSPITAL
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Covered Entity Details
Entity Name
USC ARCADIA HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050238
Entity Address
300 WEST HUNTINGTON DRIVE
ARCADIA, CA 91007
Medicare Provider Number
050238
Participating Start Date
10/1/2006
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3522
Pharmacy Address
3250 BIG DALTON AVE
BALDWIN PARK, CA 91706
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
12/15/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dan Ausman, CEO and President
(626) 574-3600
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/15/2019
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