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WAL-MART PHARMACY 10-2539
DSH500044 DEACONESS MEDICAL CENTER
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Covered Entity Details
Entity Name
DEACONESS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500044
Entity Address
800 W 5TH AVENUE
SPOKANE, WA 99204
Medicare Provider Number
500044
Participating Start Date
1/1/2019
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2539
Pharmacy Address
15727 EAST BROADWAY
SPOKANE VALLEY, WA 99037
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/16/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Wendy Hunter Apland, Chief Financial Officer
(509) 473-7961
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2019
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