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WAL-MART PHARMACY 10-0726
DSH010065 RUSSELL MEDICAL CENTER
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Covered Entity Details
Entity Name
RUSSELL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010065
Entity Address
3316 Highway 280
ALEXANDER CITY, AL 35010
Medicare Provider Number
010065
Participating Start Date
1/1/2008
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0726
Pharmacy Address
2643 HWY. 280 WEST
ALEXANDER CITY, AL 35010
Pharmacy Comments
Contract Details
Approval Date
1/20/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
L.E. Peace III, CEO
(256) 329-7188
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/20/2014
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