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WAL-MART PHARMACY 10-2641
RRC390049-28 ST. LUKES HOSPITAL
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Covered Entity Details
Entity Name
ST. LUKES HOSPITAL
Subdivision Name
ST LUKE'S HOSPITAL - Care Now Jim Thorpe
Type
Rural Referral Center
340B ID
RRC390049-28
Entity Address
1104 NORTH ST
ST LUKE'S CARE NOW
JIM THORPE, PA 18229-1717
Medicare Provider Number
390049
Outpatient Facility Provider Number
Participating Start Date
10/1/2020
Last Recertification Date
9/13/2021
Entity Termination Date
1/1/2022
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2641
Pharmacy Address
1091 MILLCREEK ROAD
ALLENTOWN, PA 18106
Pharmacy Comments
Contract Details
Approval Date
8/28/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Elizabeth Artis, Finance Director
(484) 526-4707
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/16/2020
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