Contract Pharmacy Details

WAL-MART PHARMACY 10-2007
DSH500033 SAMARITAN HOSPITAL

Covered Entity Details

Entity Name

SAMARITAN HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH500033

Entity Address

801 E WHEELER ROAD
MOSES LAKE, WA 98837

Medicare Provider Number

500033

Participating Start Date

1/1/2009

Last Recertification Date

8/20/2019

Entity Termination Date

7/1/2020

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-2007

Pharmacy Address

1005 NORTH STRATFORD ROAD
MOSES LAKE, WA 98837

Pharmacy Comments

Contract Details

Approval Date

8/17/2012

Contract Begin Date

8/17/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Thomas J. Legel, CFO
(509) 793-9710

Contract Pharmacy Representative

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

Signed By Date

7/23/2012

340B Drug Pricing Program Database