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WAL-MART PHARMACY 10-0825
DSH180048 EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180048
Entity Address
217 SOUTH THIRD STREET
DANVILLE, KY 40422
Medicare Provider Number
180048
Participating Start Date
10/1/2004
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0825
Pharmacy Address
1283 US HIGHWAY 27 NORTH
STANFORD, KY 40484
Pharmacy Comments
Contract Details
Approval Date
9/26/2012
Contract Begin Date
9/27/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BILL SNAPP, CFO
(859) 239-2435
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
9/20/2012
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