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WAL-MART PHARMACY 10-1305
RRC520098-00 UNIVERSITY OF WI HOSPITALS & CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY OF WI HOSPITALS & CLINICS
Subdivision Name
Type
Rural Referral Center
340B ID
RRC520098-00
Entity Address
600 HIGHLAND AVE
MADISON, WI 53792
Medicare Provider Number
520098
Participating Start Date
10/1/2020
Last Recertification Date
8/28/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1305
Pharmacy Address
3800 DEERFIELD DR
JANESVILLE, WI 53545
Pharmacy Comments
Contract Details
Approval Date
7/28/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/23/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert W Flannery, Senior VP/Chief Financial Officer
(608) 265-7131
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/15/2020
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