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WALMART PHARMACY 10-5169
DSH180141 UNIVERSITY OF LOUISVILLE HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF LOUISVILLE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180141
Entity Address
530 SOUTH JACKSON STREET
LOUISVILLE, KY 40202
Medicare Provider Number
180141
Participating Start Date
7/1/1996
Last Recertification Date
8/31/2024
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
Contract Termination Date
Termination Reason
7/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Amsler, Senior Vice President of Operations
(502) 562-4122
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/14/2023
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