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WAL-MART PHARMACY 10-2702
DSH260040 LESTER E COX MEDICAL CENTERS
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Covered Entity Details
Entity Name
LESTER E COX MEDICAL CENTERS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260040
Entity Address
3801 SOUTH NATIONAL AVE
SPRINGFIELD, MO 65807
Medicare Provider Number
260040
Participating Start Date
1/1/2007
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2702
Pharmacy Address
1102 NO MASSEY BLVD
NIXA, MO 65714
Pharmacy Comments
Contract Details
Approval Date
4/5/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jake McWay, SVP - CFO
(417) 269-8811
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/5/2013
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