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WAL-MART PHARMACY 10-5997
DSH340002 MISSION HOSPITALS, INC.
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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 PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
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
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