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WAL-MART PHARMACY 10-5315
RRC100062-00 AdventHealth Ocala
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Covered Entity Details
Entity Name
AdventHealth Ocala
Subdivision Name
Type
Rural Referral Center
340B ID
RRC100062-00
Entity Address
1500 SW 1st Ave
Ocala, FL 34471
Medicare Provider Number
100062
Participating Start Date
7/1/2019
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/28/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Frances H Crunk, CFO
(352) 401-8498
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/14/2020
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