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WAL-MART PHARMACY 10-1685
DSH430027 Sanford USD Medical Center
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Covered Entity Details
Entity Name
Sanford USD Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH430027
Entity Address
1305 W 18th Street
Sioux Falls, SD 57117-5039
Medicare Provider Number
430027
Participating Start Date
1/1/2013
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1685
Pharmacy Address
1730 N. GARFIELD RD.
PIERRE, SD 57501
Pharmacy Comments
Contract Details
Approval Date
4/11/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cole A Turner, Vice President, Finance
(605) 328-6940
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/11/2022
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