340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-1476
DSH180040H JEWISH HOSPITAL AND ST MARY'S HEALTHCARE (JHSMH)
Print
Covered Entity Details
Entity Name
JEWISH HOSPITAL AND ST MARY'S HEALTHCARE (JHSMH)
Subdivision Name
CANCER AND BLOOD SPECIALISTS, A SERVICE OF JEWISH HOSPITAL AND SAINT MARY'S HEALTHCARE
Type
Disproportionate Share Hospital
340B ID
DSH180040H
Entity Address
1460 BLUEGRASS AVE
LOUISVILLE, KY 40215
Medicare Provider Number
180040
Outpatient Facility Provider Number
Participating Start Date
10/8/2009
Last Recertification Date
8/19/2016
Entity Termination Date
10/1/2017
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1476
Pharmacy Address
1351 VETERANS PKWY
CLARKSVILLE, IN 47129
Pharmacy Comments
Contract Details
Approval Date
9/24/2012
Contract Begin Date
9/24/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/26/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ronald Farr, CFO, Sr. VP
(502) 540-3888
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
9/21/2012
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session