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WAL-MART PHARMACY 10-4381
SCH260094-00 COX MEDICAL CENTER BRANSON
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Covered Entity Details
Entity Name
COX MEDICAL CENTER BRANSON
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260094-00
Entity Address
525 Branson Landing Blvd
Branson, MO 65616
Medicare Provider Number
260094
Participating Start Date
7/1/2022
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4381
Pharmacy Address
1101 BRANSON HILLS PARKWAY
BRANSON, MO 65616
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DAVID Lee STRONG, CFO
(417) 335-7188
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/14/2017
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