340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-1130

Pharmacy Address

922 E MAIN STREET
LAURENS, SC 29360

Pharmacy Comments

Approval Date

8/27/2012

Contract Begin Date

9/1/2012

Carve-In Effective Date

Contract Comments

9/18/15 Contract pharmacy arrangement in 340B database terminated as a consequence of 340B Id termination. Must re-register the contract pharmacy arrangement under the new 340B ID.

Contract Termination Date
Termination Reason

10/1/2015
Business decision by covered entity and/or pharmacy

Covered Entity Signing Official

Willis Jackson Grant, Chief Financial Officer
(864) 833-3976

Contract Pharmacy Representative

Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374

Signed By Date

8/16/2012