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WAL-MART PHARMACY 10-4409
DSH110054 ATRIUM HEALTH FLOYD MEDICAL CENTER
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Covered Entity Details
Entity Name
ATRIUM HEALTH FLOYD MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110054
Entity Address
304 TURNER MCCALL BLVD
ROME, GA 30165
Medicare Provider Number
110054
Participating Start Date
7/1/2004
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4409
Pharmacy Address
1801 NATHAN DEAN BYPASS
ROCKMART, GA 30153
Pharmacy Comments
Contract Details
Approval Date
10/10/2012
Contract Begin Date
10/10/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/14/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard T. Sheerin, CFO
(706) 509-6079
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
9/30/2012
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