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WAL-MART PHARMACY 10-1113
DSH180011 SAINT JOSEPH HEALTH SYSTEM
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Covered Entity Details
Entity Name
SAINT JOSEPH HEALTH SYSTEM
Subdivision Name
DBA SAINT JOSEPH - LONDON
Type
Disproportionate Share Hospital
340B ID
DSH180011
Entity Address
1001 SAINT JOSEPH LANE
LONDON, KY 40741
Medicare Provider Number
180011
Participating Start Date
4/1/2006
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1113
Pharmacy Address
1851 WEST HWY 192
LONDON, KY 40741
Pharmacy Comments
Contract Details
Approval Date
9/7/2012
Contract Begin Date
9/7/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/12/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Brock, VP Finance and Development
(253) 426-6234
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
8/24/2012
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