Contract Pharmacy Details

WAL-MART PHARMACY 10-5315
DSH050348 UCI MEDICAL CENTER

Covered Entity Details

Entity Name

UCI MEDICAL CENTER

Subdivision Name

UNIVERSITY OF CALIFORNIA, IRVINE

Type

Disproportionate Share Hospital

340B ID

DSH050348

Entity Address

101 THE CITY DR. S RT32
ORANGE, CA 92868

Medicare Provider Number

050348

Participating Start Date

1/1/1998

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-5315

Pharmacy Address

2354 COMMERCE PARK DR.
ORLANDO, FL 32819

Pharmacy Comments

Contract Details

Approval Date

1/16/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Howard Federoff, CEO & Vice Chancellor, Health Affairs
(949) 824-5926

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

1/16/2017

340B Drug Pricing Program Database