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WALMART PHARMACY 10-5169
DSH310086 KENNEDY MEMORIAL HOSPITAL-UMC
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Covered Entity Details
Entity Name
KENNEDY MEMORIAL HOSPITAL-UMC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310086
Entity Address
18 East Laurel Road
Stratford, NJ 08084
Medicare Provider Number
310086
Participating Start Date
4/1/2016
Last Recertification Date
9/4/2024
Entity Termination Date
1/1/2025
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
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Stephen V DeStefano, Vice President Finance
(215) 587-3332
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/17/2023
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