Contract Pharmacy Details

WAL-MART PHARMACY 10-1440
DSH460009 University of Utah

Covered Entity Details

Entity Name

University of Utah

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH460009

Entity Address

50 North Medical Drive
Salt Lake City, UT 84132

Medicare Provider Number

460009

Participating Start Date

7/1/1996

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-1440

Pharmacy Address

99 WEST 1280 NORTH
TOOELE, UT 84074

Pharmacy Comments

Contract Details

Approval Date

7/14/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Charlton Gordon Park, Chief Financial Officer
(801) 585-1325

Contract Pharmacy Representative

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

Signed By Date

7/14/2022

340B Drug Pricing Program Database