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WAL-MART PHARMACY 10-2791
DSH080006 NANTICOKE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
NANTICOKE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH080006
Entity Address
801 MIDDLEFORD ROAD
SEAFORD, DE 19973
Medicare Provider Number
080006
Participating Start Date
1/1/2009
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2791
Pharmacy Address
4 COLLEGE PARK LANE
GEORGETOWN, DE 19947
Pharmacy Comments
Contract Details
Approval Date
1/4/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Donald Tricarico, VP, Clinical Services
(302) 629-6611 Ext: 2266
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/4/2016
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