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WAL-MART PHARMACY 10-5605
DSH050126 Valley Presbyterian Hospital
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Covered Entity Details
Entity Name
Valley Presbyterian Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050126
Entity Address
15107 Vanowen Street
Van Nuys, CA 91405
Medicare Provider Number
050126
Participating Start Date
1/1/2012
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5605
Pharmacy Address
14530 NORDHOFF ST.
PANORAMA CITY, CA 91402
Pharmacy Comments
Contract Details
Approval Date
10/3/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LORI CARDLE, SVP Finance, CFO
(818) 902-5235
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/3/2019
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