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WAL-MART PHARMACY 10-5315
SCH190088-00 SPRINGHILL MEDICAL CENTER - AMENDED
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Covered Entity Details
Entity Name
SPRINGHILL MEDICAL CENTER - AMENDED
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH190088-00
Entity Address
2001 DOCTORS DRIVE
SPRINGHILL, LA 71075
Medicare Provider Number
190088
Participating Start Date
1/1/2018
Last Recertification Date
8/18/2024
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
Michael G. Patronis, CEO
(318) 539-1001
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2020
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