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WAL-MART PHARMACY 10-2809
DSH510030 Davis Memorial Hospital DBA DAVIS MEDICAL CENTER
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Covered Entity Details
Entity Name
Davis Memorial Hospital DBA DAVIS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510030
Entity Address
812 Gorman Avenue
ELKINS, WV 26241
Medicare Provider Number
510030
Participating Start Date
1/1/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2809
Pharmacy Address
100 BUCKHANNON CROSSROADS
BUCKHANNON, WV 26201
Pharmacy Comments
Contract Details
Approval Date
1/8/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
REBECCA J. HAMMER, VICE PRESIDENT FOR FINANCE
(304) 637-3156
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/8/2014
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