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WAL-MART PHARMACY 10-1608
DSH050280 MERCY MEDICAL CENTER, REDDING
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER, REDDING
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050280
Entity Address
2175 ROSALINE AVENUE
REDDING, CA 96001-6009
Medicare Provider Number
050280
Participating Start Date
4/1/2006
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1608
Pharmacy Address
608 LUTHER
RED BLUFF, CA 96080
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/4/2021
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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