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WAL-MART PHARMACY 10-5047
DSH310086 KENNEDY MEMORIAL HOSPITAL-UMC
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Covered Entity Details
Entity Name
KENNEDY MEMORIAL HOSPITAL-UMC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310086
Entity Address
18 East Laurel Road
Stratford, NJ 08084
Medicare Provider Number
310086
Participating Start Date
4/1/2016
Last Recertification Date
9/4/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5047
Pharmacy Address
130 BLACKHORSE PIKE
AUDUBON, NJ 08106
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
John W Graham, VP - Chief Administrative Officer
(856) 582-2661
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/15/2020
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