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WAL-MART PHARMACY 10-2980
DSH450039 Tarrant County Hospital District d/b/a JPS Health Network
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Covered Entity Details
Entity Name
Tarrant County Hospital District d/b/a JPS Health Network
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450039
Entity Address
1500 S Main Street
FORT WORTH, TX 76104
Medicare Provider Number
450039
Participating Start Date
8/1/1993
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2980
Pharmacy Address
8520 NORTH BEACH ST
KELLER, TX 76248 MAILING ADDR
FT WORTH(N), TX 76137
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joy Parker, SVP, Operations
(817) 702-5802 Ext: 8177027143
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
4/14/2025
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