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WAL-MART PHARMACY 10-3306
DSH440039 Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic
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Covered Entity Details
Entity Name
Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440039
Entity Address
1211 MEDICAL CENTER DRIVE
NASHVILLE, TN 37232
Medicare Provider Number
440039
Participating Start Date
7/1/2002
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3306
Pharmacy Address
1220 GALLATIN AVENUE
NASHVILLE(MCKENNIE), TN 37206
Pharmacy Comments
Contract Details
Approval Date
1/2/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/29/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
Cecelia B Moore, Associate Vice Chancellor
(615) 322-0084
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/2/2015
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