340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-5145
DSH450213 UNIVERSITY HEALTH SYSTEM
Print
Covered Entity Details
Entity Name
UNIVERSITY HEALTH SYSTEM
Subdivision Name
UNIVERSITY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH450213
Entity Address
4502 MEDICAL DRIVE
SAN ANTONIO, TX 78229
Medicare Provider Number
450213
Participating Start Date
10/1/1993
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5145
Pharmacy Address
1603 VANCE JACKSON RD
SAN ANTONIO, TX 78213
Pharmacy Comments
Contract Details
Approval Date
1/15/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/2/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MARY ANN MOTE, CHIEF REVENUE OFFICER
(210) 358-2895
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/15/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session