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WAL-MART PHARMACY 10-2273
DSH230132 HURLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
HURLEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230132
Entity Address
ONE HURLEY PLAZA
FLINT, MI 48503
Medicare Provider Number
230132
Participating Start Date
12/1/1992
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2273
Pharmacy Address
5323 E COURT ST NORTH
BURTON, MI 48509
Pharmacy Comments
Contract Details
Approval Date
4/9/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/25/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Melany Gavulic, President & CEO
(810) 262-6887
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/9/2020
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