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WAL-MART PHARMACY 10-5315
DSH050067 OAK VALLEY DISTRICT HOSPITAL
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Covered Entity Details
Entity Name
OAK VALLEY DISTRICT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050067
Entity Address
350 SOUTH OAK STREET
OAKDALE, CA 95361
Medicare Provider Number
050067
Participating Start Date
4/1/2016
Last Recertification Date
8/21/2023
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ann Croskrey, CFO
(209) 848-4104
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2019
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