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WAL-MART PHARMACY 10-1190
DSH180067 UNIVERSITY OF KENTUCKY
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Covered Entity Details
Entity Name
UNIVERSITY OF KENTUCKY
Subdivision Name
UK Chandler Hospital
Type
Disproportionate Share Hospital
340B ID
DSH180067
Entity Address
800 ROSE STREET
LEXINGTON, KY 40536
Medicare Provider Number
180067
Participating Start Date
12/1/1992
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1190
Pharmacy Address
120 JILL DRIVE
BEREA, KY 40403
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Colleen Hope Swartz, Vice President for Hospital Operations
(859) 361-4496
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
10/12/2023
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