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Walmart Pharmacy 10-7611
DSH340099 East Carolina Health d/b/a ECU Health Roanoke-Chowan Hospital
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Covered Entity Details
Entity Name
East Carolina Health d/b/a ECU Health Roanoke-Chowan Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340099
Entity Address
500 SOUTH ACADEMY ST
AHOSKIE, NC 27910
Medicare Provider Number
340099
Participating Start Date
7/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles Alford, Vice President, Financial Services
(252) 641-7131
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/16/2024
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