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Walmart Pharmacy 10-7611
DSH380090 BAY AREA HOSPITAL
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Covered Entity Details
Entity Name
BAY AREA HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380090
Entity Address
1775 THOMPSON ROAD
COOS BAY, OR 97420-2125
Medicare Provider Number
380090
Participating Start Date
4/1/2022
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Jones Moore, President and CEO
(541) 269-8124
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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