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WALMART PHARMACY 10-5169
DSH420070 PRISMA HEALTH TUOMEY HOSPITAL
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Covered Entity Details
Entity Name
PRISMA HEALTH TUOMEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420070
Entity Address
129 N WASHINGTON ST
SUMTER, SC 29150-4949
Medicare Provider Number
420070
Participating Start Date
4/1/2006
Last Recertification Date
8/21/2024
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
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Bundy, Chief Executive Officer
(803) 296-5782
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/14/2023
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