340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-2515
DSH030002 Banner – University Medical Center Phoenix
Print
Covered Entity Details
Entity Name
Banner – University Medical Center Phoenix
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030002
Entity Address
1111 EAST MCDOWELL ROAD
PHOENIX, AZ 85006
Medicare Provider Number
030002
Participating Start Date
9/9/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2515
Pharmacy Address
3721 EAST THOMAS ROAD
PHOENIX (EAST), AZ 85018
Pharmacy Comments
Contract Details
Approval Date
5/31/2012
Contract Begin Date
5/31/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/31/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dennis Dahlen, Senior Vice President, CFO
(602) 747-4727
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
5/3/2012
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session