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WAL-MART PHARMACY 10-0427
DSH450236 CHRISTUS Mother Frances Hospital-Sulphur Springs - CHRISTUS Hopkins Health Alliance
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Covered Entity Details
Entity Name
CHRISTUS Mother Frances Hospital-Sulphur Springs - CHRISTUS Hopkins Health Alliance
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450236
Entity Address
115 AIRPORT ROAD
SULPHUR SPRINGS, TX 75482
Medicare Provider Number
450236
Participating Start Date
1/1/2018
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0427
Pharmacy Address
7401 INTERSTATE 30
GREENVILLE, TX 75402
Pharmacy Comments
Contract Details
Approval Date
4/2/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DONNA WALLACE, CHIEF FINANCIAL OFFICER
(903) 439-4076
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/2/2015
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