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Walmart Pharmacy 10-7611
DSH130071 St. Luke's Nampa Medical Center
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Covered Entity Details
Entity Name
St. Luke's Nampa Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH130071
Entity Address
9850 W ST LUKES DRIVE
Nampa, ID 83687
Medicare Provider Number
130071
Participating Start Date
7/1/2019
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kate Fowler, Senior VP & CFO
(208) 381-8717
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/5/2023
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