340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
DSH240002 ST MARYS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST MARYS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240002
Entity Address
402 E 2ND STREET
DULUTH, MN 55805
Medicare Provider Number
240002
Participating Start Date
7/1/2011
Last Recertification Date
8/30/2023
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/17/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Bradley Beard, Chief Operating Officer
(218) 786-2652
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/17/2023
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