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WAL-MART PHARMACY 10-1174
DSH010112 Whitfield Regional Hospital
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Covered Entity Details
Entity Name
Whitfield Regional Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010112
Entity Address
105 US HIGHWAY 80 EAST
DEMOPOLIS, AL 36732
Medicare Provider Number
010112
Participating Start Date
4/1/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1174
Pharmacy Address
34301 HIGHWAY 43
THOMASVILLE, AL 36784
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ARTHUR D. EVANS, CEO/ADMINISTRATOR
(334) 287-2502
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/15/2014
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