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WAL-MART PHARMACY 10-2704
DSH340004 HIGH POINT REGIONAL HEALTH
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Covered Entity Details
Entity Name
HIGH POINT REGIONAL HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340004
Entity Address
601 North Elm Street
High Point, NC 27262
Medicare Provider Number
340004
Participating Start Date
3/15/2022
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2704
Pharmacy Address
1021 HIGH POINT STREET
RANDLEMAN, NC 27317
Pharmacy Comments
Contract Details
Approval Date
2/12/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Edwin Smith, Vice President, Chief Operating Officer
(336) 781-2181
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/15/2021
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