Contract Pharmacy Details

WAL-MART PHARMACY 10-1694
DSH340087 THE MCDOWELL HOSPITAL, INC

Covered Entity Details

Entity Name

THE MCDOWELL HOSPITAL, INC

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340087

Entity Address

430 RANKIN DRIVE
MARION, NC 28752

Medicare Provider Number

340087

Participating Start Date

4/1/2005

Last Recertification Date

9/11/2018

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-1694

Pharmacy Address

2875 SUGAR HILL RD
MARION, NC 28752

Pharmacy Comments

Contract Details

Approval Date

9/21/2012

Contract Begin Date

9/21/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Lynn Boggs, CEO
(828) 659-5100

Contract Pharmacy Representative

Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374

Signed By Date

8/17/2012

340B Drug Pricing Program Database