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WALMART PHARMACY 10-5169
DSH390056 JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)
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Covered Entity Details
Entity Name
JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390056
Entity Address
1225 WARM SPRINGS AVENUE
HUNTINGDON, PA 16652-2350
Medicare Provider Number
390056
Participating Start Date
1/1/2024
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
11/29/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Myers, President, CEO
(814) 643-8445
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/4/2023
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