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WAL-MART PHARMACY 10-5039
DSH080004 BAYHEALTH MEDICAL CENTER INC.
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Covered Entity Details
Entity Name
BAYHEALTH MEDICAL CENTER INC.
Subdivision Name
KENT GENERAL HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH080004
Entity Address
640 SOUTH STATE STREET
DOVER, DE 19901-3597
Medicare Provider Number
080004
Participating Start Date
4/1/2009
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5039
Pharmacy Address
263 WAL-MART DR
CAMDEN, DE 19934
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/20/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael James Tretina, CFO
(302) 744-7162
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/13/2016
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