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WAL-MART PHARMACY 10-0366
DSH440084 SWEETWATER HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
SWEETWATER HOSPITAL ASSOCIATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440084
Entity Address
304 WRIGHT STREET
SWEETWATER, TN 37874
Medicare Provider Number
440084
Participating Start Date
7/1/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0366
Pharmacy Address
4525 HWY 411
MADISONVILLE, TN 37354
Pharmacy Comments
Contract Details
Approval Date
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ashley Gail Shamblin, Chief Financial Officer
(865) 213-8582
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/14/2023
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