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Walmart Pharmacy 10-7611
DSH450080 TITUS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
TITUS REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450080
Entity Address
2001 N. JEFFERSON
MT. PLEASANT, TX 75455
Medicare Provider Number
450080
Participating Start Date
7/1/2008
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/7/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Terry Scoggin, CEO
(903) 577-6066
Contract Pharmacy Representative
Walmart
Van Donn, 340B Director Contracting
(479) 273-4000
Signed By Date
10/7/2023
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