340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALMART PHARMACY 10-3107
SCH450010-00 United Regional Health Care System
Print
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
WALMART PHARMACY 10-3107
Pharmacy Address
24403 IH 10 W
SAN ANTONIO, TX 78255
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
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session