Contract Pharmacy Details

WAL-MART PHARMACY 10-3503
RRC340004-00 HIGH POINT REGIONAL HEALTH

Covered Entity Details

Entity Name

HIGH POINT REGIONAL HEALTH

Subdivision Name

Type

Rural Referral Center

340B ID

RRC340004-00

Entity Address

601 North Elm Street
High Point, NC 27262

Medicare Provider Number

340004

Participating Start Date

12/27/2021

Last Recertification Date

Entity Termination Date

3/15/2022

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-3503

Pharmacy Address

1585 LIBERTY DRIVE, STE #1
THOMASVIELLE, NC 27360

Pharmacy Comments

Contract Details

Approval Date

1/13/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/15/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kevin Edwin Smith, Vice President, Chief Operating Officer
(336) 781-2181

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

1/13/2022

340B Drug Pricing Program Database