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Walmart Pharmacy 10-7611
DSH180070 Owensboro Health Twin Lakes Regional Medical Center, Inc
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Covered Entity Details
Entity Name
Owensboro Health Twin Lakes Regional Medical Center, Inc
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180070
Entity Address
910 WALLACE AVENUE
LEITCHFIELD, KY 42754
Medicare Provider Number
180070
Participating Start Date
4/1/2006
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/10/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ashley Herrington, CEO
(270) 259-9510
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/10/2024
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