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WAL-MART PHARMACY 10-3229
SCH450010-00 United Regional Health Care System
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Covered Entity Details
Entity Name
United Regional Health Care System
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450010-00
Entity Address
1600 11th Street
Wichita Falls, TX 76301
Medicare Provider Number
450010
Participating Start Date
1/1/2013
Last Recertification Date
9/14/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3229
Pharmacy Address
3800 HWY 287 WEST
VERNON, TX 76384
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert M. Pert, Chief Financial Officer
(940) 764-3023
Contract Pharmacy Representative
Walmart
Jodi Prohofsky, Sr. Director
(479) 277-1498
Signed By Date
7/12/2019
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