340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-1616

Pharmacy Address

2900 MAIN STREET
SUSANVILLE, CA 96130

Pharmacy Comments

Approval Date

2/28/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/18/2016
Business decision by covered entity and/or pharmacy

Covered Entity Signing Official

Dave Kaubisch, Vice President of Finance
(602) 747-4556

Contract Pharmacy Representative

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

Signed By Date

1/15/2013