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Walmart Pharmacy 10-7611
SCH110109-00 EMANUEL MEDICAL CENTER
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Covered Entity Details
Entity Name
EMANUEL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH110109-00
Entity Address
117 KITE ROAD
SWAINSBORO, GA 30401
Medicare Provider Number
110109
Participating Start Date
12/14/2021
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/14/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Damien Scott, CEO
(478) 289-1306
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/11/2023
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