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WAL-MART PHARMACY 10-5315
DSH340090 Johnston Health Services Corporation
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Covered Entity Details
Entity Name
Johnston Health Services Corporation
Subdivision Name
Johnston Memorial Hospital
Type
Disproportionate Share Hospital
340B ID
DSH340090
Entity Address
509 N BRIGHTLEAF BLVD
SMITHFIELD, NC 27577
Medicare Provider Number
340090
Participating Start Date
7/1/2004
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ruth L Marler, COO/CNO
(919) 938-7383
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2020
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