340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-1789
DSH050084 ST JOSEPH'S MEDICAL CENTER
Print
Covered Entity Details
Entity Name
ST JOSEPH'S MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050084
Entity Address
1800 N CALIFORNIA STREET
STOCKTON, CA 95204
Medicare Provider Number
050084
Participating Start Date
1/1/2005
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1789
Pharmacy Address
1601 S. LOWER SACRAMENTO RD.
LODI, CA 95242
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Donald J Wiley, President and CEO
(209) 467-6384
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/14/2019
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