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WAL-MART PHARMACY 10-0678
DSH440050 Greeneville Community Hospital
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Covered Entity Details
Entity Name
Greeneville Community Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440050
Entity Address
1420 Tusculum Blvd
GREENEVILLE, TN 37745
Medicare Provider Number
440050
Participating Start Date
7/1/2009
Last Recertification Date
8/30/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0678
Pharmacy Address
1075 COSBY HIGHWAY
NEWPORT, TN 37821
Pharmacy Comments
Contract Details
Approval Date
7/12/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/3/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Todd j. Dougan, CFO
(423) 230-8512
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/12/2017
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