340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-0027

Pharmacy Address

1101 HWY 32 WEST
SALEM, MO 65560

Pharmacy Comments

Approval Date

7/20/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

KASEY LUCAS, ASSISTANT ADMINISTRATOR
(573) 729-5917 Ext: 4003

Contract Pharmacy Representative

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

Signed By Date

7/20/2015