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WAL-MART PHARMACY 10-5315
DSH180088 NORTON HOSPITALS, INC
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Covered Entity Details
Entity Name
NORTON HOSPITALS, INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180088
Entity Address
200 East Chestnut Street
LOUISVILLE, KY 40202
Medicare Provider Number
180088
Participating Start Date
1/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/17/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Adam David Kempf, CFO
(502) 420-2255
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/17/2020
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