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WAL-MART PHARMACY 10-5315
SCH110071-00 Appling General Hospital
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Covered Entity Details
Entity Name
Appling General Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH110071-00
Entity Address
163 E Tollison Street
Baxley, GA 31513
Medicare Provider Number
110071
Participating Start Date
1/1/2014
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Randall T Crawford, CEO
(912) 367-9841 Ext: 1202
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/10/2020
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