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WALMART PHARMACY 10-5169
DSH490009 UNIVERSITY OF VIRGINIA MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF VIRGINIA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490009
Entity Address
1215 Lee Street
RECVG LANE RD-LOADING DOCK
CHARLOTTESVILLE, VA 22908
Medicare Provider Number
490009
Participating Start Date
7/1/1993
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
10/6/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Wilmoth, Strategic Planning and Reimbursement Officer
(434) 243-9802
Contract Pharmacy Representative
Wal Mart
Tisha Campbell, Director Contracting
(434) 465-8049
Signed By Date
10/6/2023
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