Contract Pharmacy Details

WAL-MART CENTRAL FILL 10-2670
DSH340002 MISSION HOSPITALS, INC.

Covered Entity Details

Entity Name

MISSION HOSPITALS, INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340002

Entity Address

509 BILTMORE AVENUE
ASHEVILLE, NC 28801

Medicare Provider Number

340002

Participating Start Date

7/1/2004

Last Recertification Date

8/29/2018

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

WAL-MART CENTRAL FILL 10-2670

Pharmacy Address

608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386

Pharmacy Comments

Contract Details

Approval Date

7/8/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Paul L McDowell, CFO
(828) 213-0184

Contract Pharmacy Representative

Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719

Signed By Date

7/8/2015

340B Drug Pricing Program Database