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WAL-MART PHARMACY 10-3262
DSH360039 GENESIS HEALTHCARE SYSTEM
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Covered Entity Details
Entity Name
GENESIS HEALTHCARE SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360039
Entity Address
2951 MAPLE AVE.
ZANESVILLE, OH 43701-1406
Medicare Provider Number
360039
Participating Start Date
7/1/2007
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3262
Pharmacy Address
61205 SOUTHGATE PKWY.
CAMBRIDGE, OH 43725
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/26/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PAUL D. MASTERSON, CFO
(740) 454-4637
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2016
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