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WAL-MART PHARMACY 10-1478
DSH180009 KING'S DAUGHTERS MEDICAL CENTER
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Covered Entity Details
Entity Name
KING'S DAUGHTERS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180009
Entity Address
2201 LEXINGTON AVENUE
ASHLAND, KY 41101
Medicare Provider Number
180009
Participating Start Date
4/1/2006
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1478
Pharmacy Address
354 PRIVATE DRIVE 288
SOUTH POINT, OH 45680
Pharmacy Comments
Contract Details
Approval Date
11/5/2012
Contract Begin Date
11/5/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul McDowell, CFO
(606) 408-4404
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
9/27/2012
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