340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
DSH510008 City Hospital, Inc. DBA Berkeley Medical Center
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Covered Entity Details
Entity Name
City Hospital, Inc. DBA Berkeley Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510008
Entity Address
2500 HOSPITAL DRIVE
MARTINSBURG, WV 25401
Medicare Provider Number
510008
Participating Start Date
10/1/2007
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Grover Glendon Kerns, VP of Finance
(304) 260-1443
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/9/2023
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