340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-2013

Pharmacy Address

80 WATERVILLE COMMONS DRIVE
WATERVILLE, ME 04901

Pharmacy Comments

Approval Date

4/15/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

MICHAEL KOZIOL, SR VP/CHIEF FINANCIAL OFFICER
(207) 626-1212

Contract Pharmacy Representative

Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719

Signed By Date

4/15/2014