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WAL-MART PHARMACY 10-5315
SCH110109-00 EMANUEL MEDICAL CENTER
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Covered Entity Details
Entity Name
EMANUEL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH110109-00
Entity Address
117 KITE ROAD
SWAINSBORO, GA 30401
Medicare Provider Number
110109
Participating Start Date
12/14/2021
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
12/17/2021
Contract Begin Date
12/17/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/14/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Damien Scott, CEO
(478) 289-1306
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
12/17/2021
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