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WAL-MART PHARMACY 10-2329
DSH220095 HENRY HEYWOOD MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
HENRY HEYWOOD MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220095
Entity Address
242 GREEN STREET
GARDNER, MA 01440
Medicare Provider Number
220095
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2329
Pharmacy Address
555 EAST MAIN STREET
ORANGE, MA 01364
Pharmacy Comments
Contract Details
Approval Date
10/5/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Abbatiello, CFO
(978) 630-6157
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/5/2021
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