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WAL-MART PHARMACY 10-1769
DSH390086 DUBOIS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
DUBOIS REGIONAL MEDICAL CENTER
Subdivision Name
dba Penn Highlands DuBois
Type
Disproportionate Share Hospital
340B ID
DSH390086
Entity Address
100 HOSPITAL AVENUE
DUBOIS, PA 15801
Medicare Provider Number
390086
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1769
Pharmacy Address
20 INDUSTRIAL DRIVE
DU BOIS, PA 15801
Pharmacy Comments
Contract Details
Approval Date
1/18/2012
Contract Begin Date
1/18/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patricia Cressley, CFO
(814) 375-6299
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/11/2012
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