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Walmart Pharmacy 10-7611
DSH050057 Kaweah Delta Health Care District DBA Kaweah Health
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Covered Entity Details
Entity Name
Kaweah Delta Health Care District DBA Kaweah Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050057
Entity Address
400 West Mineral King Avenue
Visalia, CA 93291
Medicare Provider Number
050057
Participating Start Date
7/1/2004
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary K Herbst, Chief Executive Officer
(559) 624-2330
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/10/2023
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