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WAL-MART PHARMACY 10-4221
DSH380021 TUALITY HEALTHCARE
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Covered Entity Details
Entity Name
TUALITY HEALTHCARE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380021
Entity Address
335 SE 8TH AVE
HILLSBORO, OR 97123
Medicare Provider Number
380021
Participating Start Date
7/1/2010
Last Recertification Date
9/2/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4221
Pharmacy Address
220 N ADAIR
CORNELIUS, OR 97113
Pharmacy Comments
Contract Details
Approval Date
1/12/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TIMOTHY L. FLEISCHMANN, CFO
(503) 681-1579
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/12/2015
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