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WAL-MART PHARMACY 10-1476
DSH180040 UofL Health -- Louisville
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Covered Entity Details
Entity Name
UofL Health -- Louisville
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180040
Entity Address
200 ABRAHAM FLEXNER WAY
LOUISVILLE, KY 40202-1818
Medicare Provider Number
180040
Participating Start Date
12/6/2005
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1476
Pharmacy Address
1351 VETERANS PKWY
CLARKSVILLE, IN 47129
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John D. Clagg, Vice President, Financial Analytics and Support
(502) 560-8357
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2019
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