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WAL-MART PHARMACY 10-2548
DSH180044 PIKEVILLE MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
PIKEVILLE MEDICAL CENTER, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180044
Entity Address
911 BYPASS ROAD
PIKEVILLE, KY 41501
Medicare Provider Number
180044
Participating Start Date
1/1/2007
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2548
Pharmacy Address
28402 U.S. HWY 119 NO.
SO WILLIAMSON, KY 41503
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHELLE HAGY, CFO
(606) 430-3519
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/17/2017
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