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WALMART PHARMACY #10-3635
DSH440104 Erlanger Health
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Covered Entity Details
Entity Name
Erlanger Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440104
Entity Address
975 East Third Street
CHATTANOOGA, TN 37403
Medicare Provider Number
440104
Participating Start Date
12/1/1992
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY #10-3635
Pharmacy Address
1155 BATTLEFIELD PKWY
FORT OGLETHORPE, GA 30742
Pharmacy Comments
Contract Details
Approval Date
4/9/2020
Contract Begin Date
4/30/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRITTON J. TABOR, CFO
(423) 778-7729
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/9/2020
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