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WAL-MART PHARMACY 10-2278
DSH390009 SAINT VINCENT HEALTH CENTER
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Covered Entity Details
Entity Name
SAINT VINCENT HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390009
Entity Address
232 WEST 25TH STREET
ERIE, PA 16544-0002
Medicare Provider Number
390009
Participating Start Date
7/1/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2278
Pharmacy Address
1825 DOWNS DRIVE
ERIE, PA 16509
Pharmacy Comments
Contract Details
Approval Date
7/7/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
THOMAS FUCCI, EXECUTIVE VICE PRESIDENT AND CHIEF OPERATING OFFICER
(814) 452-5112
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/7/2014
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