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WAL-MART PHARMACY 10-5732
DSH330394 UNITED HEALTH SERVICES HOSPITALS, INC.
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Covered Entity Details
Entity Name
UNITED HEALTH SERVICES HOSPITALS, INC.
Subdivision Name
Binghamton General Hospital
Type
Disproportionate Share Hospital
340B ID
DSH330394
Entity Address
10-42 MITCHELL AVENUE
BINGHAMTON, NY 13903
Medicare Provider Number
330394
Participating Start Date
9/4/2009
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5732
Pharmacy Address
2 GANNETT DRIVE
JOHNSON CITY, NY 13790
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Arthur Schmidt, Vice President, Clinical Services
(607) 762-3359
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/14/2021
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