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WAL-MART PHARMACY 10-1880
DSH380090 BAY AREA HOSPITAL
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Covered Entity Details
Entity Name
BAY AREA HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380090
Entity Address
1775 THOMPSON ROAD
COOS BAY, OR 97420-2125
Medicare Provider Number
380090
Participating Start Date
4/1/2022
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1880
Pharmacy Address
2051 NEWMARK AVENUE
COOS BAY, OR 97420
Pharmacy Comments
Contract Details
Approval Date
7/8/2022
Contract Begin Date
8/12/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Jones Moore, President and CEO
(541) 269-8124
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/8/2022
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