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WAL-MART PHARMACY 10-2537
CAH051319-00 DIGNITY HEALTH D/B/A MERCY MEDICAL CENTER MT. SHASTA
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Covered Entity Details
Entity Name
DIGNITY HEALTH D/B/A MERCY MEDICAL CENTER MT. SHASTA
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051319-00
Entity Address
914 PINE STREET.
MOUNT SHASTA, CA 96067
Medicare Provider Number
051319
Participating Start Date
9/8/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2537
Pharmacy Address
1515 DANA DRIVE
REDDING, CA 96003
Pharmacy Comments
03/01/2013 zip update (was 96002)
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/12/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph D'Angina, CFO
(530) 225-6121
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/15/2020
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