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WAL-MART PHARMACY 10-2610
DSH510007 ST. MARYS MEDICAL CENTER INC.
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Covered Entity Details
Entity Name
ST. MARYS MEDICAL CENTER INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510007
Entity Address
2900 FIRST AVENUE
HUNTINGTON, WV 25702-1241
Medicare Provider Number
510007
Participating Start Date
7/1/2016
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2610
Pharmacy Address
77 NORMAN MORGAN BLVD
LOGAN, WV 25601
Pharmacy Comments
Contract Details
Approval Date
1/12/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angela Swearingen, VP Finance/CFO
(304) 526-1224
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/12/2021
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