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WAL-MART PHARMACY 10-0089
DSH260141 University of Missouri Health Care
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Covered Entity Details
Entity Name
University of Missouri Health Care
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260141
Entity Address
One Hospital Drive
Columbia, MO 65212
Medicare Provider Number
260141
Participating Start Date
12/1/1992
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0089
Pharmacy Address
94 CECIL ST
CAMDENTON, MO 65020
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Curtright, CEO
(573) 884-8738
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/13/2020
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