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Walmart Pharmacy 10-7611
DSH290001 RENOWN REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
RENOWN REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH290001
Entity Address
1155 MILL STREET
RENO, NV 89502-1474
Medicare Provider Number
290001
Participating Start Date
4/1/2009
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/8/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brett Moore, CFO Acute Care
(775) 982-6343
Contract Pharmacy Representative
Walmart
Van Donn, 340B Director Contracting
(479) 273-4000
Signed By Date
1/8/2024
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