340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
DSH010021 DALE MEDICAL CENTER
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Covered Entity Details
Entity Name
DALE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010021
Entity Address
126 HOSPITAL AVENUE
OZARK, AL 36360
Medicare Provider Number
010021
Participating Start Date
1/1/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
7/1/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rick Wright, CFO
(334) 774-2601 Ext: 1256
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/1/2024
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