340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-1375
DSH100142 JACKSON HOSPITAL
Print
Covered Entity Details
Entity Name
JACKSON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100142
Entity Address
4250 HOSPITAL DRIVE
MARIANNA, FL 32446
Medicare Provider Number
100142
Participating Start Date
4/1/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1375
Pharmacy Address
2255 HIGHWAY 71
MARIANNA, FL 32448
Pharmacy Comments
Contract Details
Approval Date
2/22/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/15/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Larry Meese, CEO
(850) 526-2200
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/11/2013
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