Contract Pharmacy Details

WAL-MART PHARMACY #10-4459
DSH340147 NASH HOSPITALS, INC.

Covered Entity Details

Entity Name

NASH HOSPITALS, INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340147

Entity Address

2460 CURTIS ELLIS DRIVE
ROCKY MOUNT, NC 27804

Medicare Provider Number

340147

Participating Start Date

10/1/2004

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY #10-4459

Pharmacy Address

1205 EASTERN AVE.
NASHVILLE, NC 27856

Pharmacy Comments

Contract Details

Approval Date

4/8/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/5/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

AL HOOKS, CFO
(252) 962-8076

Contract Pharmacy Representative

Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374

Signed By Date

4/8/2014

340B Drug Pricing Program Database