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WAL-MART PHARMACY 10-5315
SCH450348-00 FALLS COMMUNITY HOSPITAL AND CLINIC
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Covered Entity Details
Entity Name
FALLS COMMUNITY HOSPITAL AND CLINIC
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450348-00
Entity Address
322 COLEMAN
MARLIN, TX 76661
Medicare Provider Number
450348
Participating Start Date
1/1/2017
Last Recertification Date
9/15/2021
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jeffrey Lyle, CEO
(254) 803-3561 Ext: 2101
Contract Pharmacy Representative
Walmart
Julie Howard, Manager Contracting & Channel Management
(479) 277-3719
Signed By Date
7/14/2020
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