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WAL-MART PHARMACY 10-1233
DSH180005 HIGHLANDS ARH REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HIGHLANDS ARH REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180005
Entity Address
5000 KY RT 321
PRESTONSBURG, KY 41653
Medicare Provider Number
180005
Participating Start Date
9/9/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1233
Pharmacy Address
470 NO. MAYO TRAIL
PAINTSVILLE, KY 41240
Pharmacy Comments
Contract Details
Approval Date
10/10/2019
Contract Begin Date
1/1/2020
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
10/10/2019
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