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WAL-MART PHARMACY 10-4428
DSH340023 ADVENTHEALTH HENDERSONVILLE
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Covered Entity Details
Entity Name
ADVENTHEALTH HENDERSONVILLE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340023
Entity Address
100 HOSPITAL DRIVE
HENDERSONVILLE, NC 28792
Medicare Provider Number
340023
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4428
Pharmacy Address
1636 HENDERSONVILLE RD.
ASHEVILLE, NC 28803
Pharmacy Comments
Contract Details
Approval Date
4/7/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Karsten Randolph, VP/CFO
(828) 681-2420
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/7/2014
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