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WAL-MART PHARMACY 10-2039
DSH050444 MERCY MEDICAL CENTER MERCED
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER MERCED
Subdivision Name
COMMUNITY CAMPUS
Type
Disproportionate Share Hospital
340B ID
DSH050444
Entity Address
333 MERCY AVE
MERCED, CA 95340
Medicare Provider Number
050444
Participating Start Date
7/1/1994
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2039
Pharmacy Address
3055 LOUGHBOROUGH DRIVE
MERCED, CA 95348
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/10/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Strasser, CFO
(209) 564-5003
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2019
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