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WAL-MART PHARMACY 10-2611
DSH390041 UNIONTOWN HOSPITAL
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Covered Entity Details
Entity Name
UNIONTOWN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390041
Entity Address
500 WEST BERKELEY STREET
UNIONTOWN, PA 15401
Medicare Provider Number
390041
Participating Start Date
4/1/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2611
Pharmacy Address
2100 SUMMIT RIDGE PLAZA
MT PLEASANT, PA 15666
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barbara Ann Weiss, Executive Director, Finance/CFO
(724) 430-5222
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/14/2021
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