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WALMART PHARMACY 10-5169
DSH390198 MILLCREEK COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
MILLCREEK COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390198
Entity Address
5515 Peach Street
ERIE, PA 16509
Medicare Provider Number
390198
Participating Start Date
12/28/2020
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marcus Chase Babiak, Chief Operating Officer
(814) 868-7733
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/17/2023
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