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WAL-MART PHARMACY 10-5997
DSH340127 GRANVILLE MEDICAL CENTER
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Covered Entity Details
Entity Name
GRANVILLE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340127
Entity Address
1010 COLLEGE STREET
OXFORD, NC 27565
Medicare Provider Number
340127
Participating Start Date
7/1/2004
Last Recertification Date
8/23/2024
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
1/24/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffery M. Armstrong, CFO
(919) 690-3402
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/24/2017
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