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WAL-MART PHARMACY 10-1665
DSH150089 INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC.
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Covered Entity Details
Entity Name
INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150089
Entity Address
2401 W. UNIVERSITY AVENUE
MUNCIE, IN 47303
Medicare Provider Number
150089
Participating Start Date
1/1/2010
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1665
Pharmacy Address
4801 W. CLARA LN
MUNCIE, IN 47304
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
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
1/14/2021
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