340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-2849
DSH510012 PLEASANT VALLEY HOSPITAL
Print
Covered Entity Details
Entity Name
PLEASANT VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510012
Entity Address
2520 VALLEY DRIVE
POINT PLEASANT, WV 25550
Medicare Provider Number
510012
Participating Start Date
7/1/2006
Last Recertification Date
8/14/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2849
Pharmacy Address
320 MALLARD LANE
MASON, WV 25260
Pharmacy Comments
Contract Details
Approval Date
7/7/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Richard Hogan, CHIEF FINANCIAL OFFICER
(304) 675-6270
Contract Pharmacy Representative
Wal--Mart
Marcus Osborne, Sales & Contracting
(479) 204-8452
Signed By Date
7/7/2015
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session