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WAL-MART PHARMACY 10-5315
DSH450154 Val Verde Regional Medical Center
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Covered Entity Details
Entity Name
Val Verde Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450154
Entity Address
801 Bedell Avenue
Del Rio, TX 78840
Medicare Provider Number
450154
Participating Start Date
1/1/2012
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Linda Sue Walker, Chief Executive Officer
(830) 703-1749
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/14/2020
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