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WAL-MART PHARMACY 10-2032
DSH050082 ST JOHNS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ST JOHNS REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050082
Entity Address
1600 N ROSE AVE
OXNARD, CA 93030
Medicare Provider Number
050082
Participating Start Date
1/1/2007
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2032
Pharmacy Address
2001 NORTH ROSE AVENUE
OXNARD, CA 93036
Pharmacy Comments
Contract Details
Approval Date
1/16/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/15/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ROBERT WARDWELL, VP CFO
(805) 988-2754
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/16/2014
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