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WAL-MART PHARMACY 10-0122
DSH260183 SAINT FRANCIS MEDICAL CENTER
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Covered Entity Details
Entity Name
SAINT FRANCIS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260183
Entity Address
211 SAINT FRANCIS DRIVE
CAPE GIRARDEAU, MO 63703
Medicare Provider Number
260183
Participating Start Date
7/1/2010
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0122
Pharmacy Address
3051 EAST JACKSON BLVD
JACKSON, MO 63755
Pharmacy Comments
Contract Details
Approval Date
4/4/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Ann Newcomer, Vice President - Regional Operations
(573) 331-5191
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
4/4/2025
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