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WAL-MART CENTRAL FILL 10-2670
DSH440049 METHODIST HEALTHCARE - MEMPHIS HOSPITALS
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Covered Entity Details
Entity Name
METHODIST HEALTHCARE - MEMPHIS HOSPITALS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440049
Entity Address
1265 Union Ave
Memphis, TN 38104
Medicare Provider Number
440049
Participating Start Date
7/1/2004
Last Recertification Date
9/6/2024
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
7/18/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/26/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CHRIS MCLEAN, SENIOR VP/CFO
(901) 516-0753
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/18/2017
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