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WAL-MART PHARMACY 10-5315
DSH030036 CHANDLER REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CHANDLER REGIONAL MEDICAL CENTER
Subdivision Name
CHANDLER REGIONAL MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH030036
Entity Address
1955 W. Frye Road
CHANDLER, AZ 85224
Medicare Provider Number
030036
Participating Start Date
1/1/2015
Last Recertification Date
9/4/2020
Entity Termination Date
10/5/2021
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/4/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/28/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Eric Sorensen, CFO
(480) 728-3144 Ext: 4807283144
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
10/4/2019
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