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Walmart Pharmacy 10-7611
DSH340091 THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION
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Covered Entity Details
Entity Name
THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340091
Entity Address
1200 NORTH ELM STREET
GREENSBORO, NC 27401-1020
Medicare Provider Number
340091
Participating Start Date
4/1/2006
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/14/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew Barrow, Chief Financial Officer
(336) 832-7825
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/14/2024
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