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WAL-MART PHARMACY 10-5078
DSH500036 YAKIMA VALLEY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
YAKIMA VALLEY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500036
Entity Address
2811 TIETON DR.
YAKIMA, WA 98902
Medicare Provider Number
500036
Participating Start Date
12/1/1992
Last Recertification Date
8/17/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5078
Pharmacy Address
6600 W NOB HILL BLVD
YAKIMA, WA 98908
Pharmacy Comments
Contract Details
Approval Date
8/24/2012
Contract Begin Date
8/24/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/14/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
SCOTT OLANDER, CHIEF FINANCIAL OFFICER
(509) 249-5201
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
8/2/2012
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