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WAL-MART PHARMACY 10-2894
DSH210017 GRMC, Inc. dba Garrett Regional Medical Center
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Covered Entity Details
Entity Name
GRMC, Inc. dba Garrett Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210017
Entity Address
251 NORTH FOURTH ST.
OAKLAND, MD 21550
Medicare Provider Number
210017
Participating Start Date
10/1/2016
Last Recertification Date
8/23/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2894
Pharmacy Address
13164 GARRETT HIGHWAY
OAKLAND, MD 21550
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Lori Dixon, Senior Director of Finance
(301) 533-4251
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/17/2023
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