Contract Pharmacy Details

WAL-MART PHARMACY 10-4277
DSH510055 Cabell Huntington Hospital, Inc.

Covered Entity Details

Entity Name

Cabell Huntington Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH510055

Entity Address

1340 Hal Greer Blvd.
Huntington, WV 25701-0195

Medicare Provider Number

510055

Participating Start Date

4/1/2005

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-4277

Pharmacy Address

167 PROGRESS WAY
HURRICANE, WV 25526

Pharmacy Comments

Contract Details

Approval Date

1/15/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

David M Ward, Sr. Vp/Cfo
(304) 526-2055

Contract Pharmacy Representative

Wal-Mart
Jodi Prohofsky, Sr. Director, Payer Relations
(254) 301-6601

Signed By Date

1/15/2020

340B Drug Pricing Program Database