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WAL-MART PHARMACY 10-0785
DSH250077 WAYNE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
WAYNE GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250077
Entity Address
950 MATTHEW DRIVE
WAYNESBORO, MS 39367
Medicare Provider Number
250077
Participating Start Date
4/1/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0785
Pharmacy Address
1350 AZALEA DR
WAYNESBORO, MS 39367
Pharmacy Comments
Contract Details
Approval Date
1/17/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathy Waddell, CEO
(601) 735-5151 Ext: 100
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/17/2017
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