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WAL-MART PHARMACY 10-0524
DSH450597 DEWITT MEDICAL DISTRICT DBA CUERO REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
DEWITT MEDICAL DISTRICT DBA CUERO REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450597
Entity Address
2550 N ESPLANADE ST
CUERO, TX 77954-4736
Medicare Provider Number
450597
Participating Start Date
1/1/2005
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0524
Pharmacy Address
200 BUSINESS PARK DR
KENEDY, TX 78119
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GREG PRITCHETT, CFO
(361) 275-0504
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/12/2019
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