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WAL-MART PHARMACY 10-5489
DSH340008 SCOTLAND MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SCOTLAND MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340008
Entity Address
500 LAUCHWOOD DRIVE
LAURINBURG, NC 28352
Medicare Provider Number
340008
Participating Start Date
7/1/2004
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5489
Pharmacy Address
930 HWY 711 EAST
PEMBROKE, NC 28372
Pharmacy Comments
Contract Details
Approval Date
7/8/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GREG WOOD, PRESIDENT AND CEO
(910) 291-7000 Ext: 7501
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/8/2014
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