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WALMART PHARMACY 10-4068
DSH460043 OREM COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
OREM COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH460043
Entity Address
331 NORTH 400 WEST
OREM, UT 84057
Medicare Provider Number
460043
Participating Start Date
3/15/2022
Last Recertification Date
9/6/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4068
Pharmacy Address
1206 N. CANYON CREEK PARKWAY
SPANISH FORK, UT 84660
Pharmacy Comments
Contract Details
Approval Date
7/10/2019
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Craig Carrier, Finance Director
(801) 855-3503
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/10/2019
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