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WAL-MART PHARMACY 10-2278
DSH390198 MILLCREEK COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
MILLCREEK COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390198
Entity Address
5515 Peach Street
ERIE, PA 16509
Medicare Provider Number
390198
Participating Start Date
12/28/2020
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2278
Pharmacy Address
1825 DOWNS DRIVE
ERIE, PA 16509
Pharmacy Comments
Contract Details
Approval Date
12/28/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marcus Chase Babiak, Chief Operating Officer
(814) 868-7733
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
12/18/2020
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