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WAL-MART PHARMACY 10-0845
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 10-0845
Pharmacy Address
1250 W DALLAS
BUFFALO, MO 65622
Pharmacy Comments
Contract Details
Approval Date
7/12/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jake McWay, SVP - CFO
(417) 269-8811
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/12/2013
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