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WAL-MART PHARMACY 10-1247
DSH180029 HAZARD ARH REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HAZARD ARH REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180029
Entity Address
100 MEDICAL CENTER DRIVE
HAZARD, KY 41701
Medicare Provider Number
180029
Participating Start Date
10/1/2004
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1247
Pharmacy Address
120 DANIEL BOONE PLAZA
HAZARD, KY 41701
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/12/2019
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