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WAL-MART PHARMACY 10-5743
DSH340090 Johnston Health Services Corporation
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Covered Entity Details
Entity Name
Johnston Health Services Corporation
Subdivision Name
Johnston Memorial Hospital
Type
Disproportionate Share Hospital
340B ID
DSH340090
Entity Address
509 N BRIGHTLEAF BLVD
SMITHFIELD, NC 27577
Medicare Provider Number
340090
Participating Start Date
7/1/2004
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5743
Pharmacy Address
5141 NC HWY 42
GARNER, NC 27529
Pharmacy Comments
Contract Details
Approval Date
12/3/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/20/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Charles W. Elliott Jr., CEO
(919) 938-7111
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/22/2012
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