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WAL-MART PHARMACY 10-3484
DSH100093 BAPTIST HOSPITAL
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Covered Entity Details
Entity Name
BAPTIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100093
Entity Address
123 Baptist Way
PENSACOLA, FL 32503
Medicare Provider Number
100093
Participating Start Date
4/1/2009
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3484
Pharmacy Address
2951 SOUTH BLUE ANGEL PARKWAY
PENSACOLA (SW), FL 32506
Pharmacy Comments
Contract Details
Approval Date
7/12/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sharon Nobles, CFO
(850) 469-2315
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/12/2016
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