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WAL-MART CENTRAL FILL 10-2670
DSH150051 IU HEALTH BLOOMINGTON HOSPITAL
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Covered Entity Details
Entity Name
IU HEALTH BLOOMINGTON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150051
Entity Address
2651 EAST DISCOVERY PARKWAY
BLOOMINGTON, IN 47408
Medicare Provider Number
150051
Participating Start Date
10/1/2016
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
1/13/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/26/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer M. Alvey, SVP & CFO
(317) 963-0213
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/13/2021
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