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WALMART PHARMACY 10-4673
DSH010029 EAST ALABAMA MEDICAL CENTER
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Covered Entity Details
Entity Name
EAST ALABAMA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010029
Entity Address
2000 PEPPERELL PARKWAY
OPELIKA, AL 36801-5422
Medicare Provider Number
010029
Participating Start Date
10/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4673
Pharmacy Address
1810 SHUG JORDAN PARKWAY
AUBURN, AL 36832
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/17/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
SAM PRICE, CFO
(334) 528-1313
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2016
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