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WAL-MART PHARMACY 10-0726
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
WAL-MART PHARMACY 10-0726
Pharmacy Address
2643 HWY. 280 WEST
ALEXANDER CITY, AL 35010
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SAM PRICE, CFO
(334) 528-1313
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/15/2016
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