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WAL-MART PHARMACY 10-1048
CH04216A DAYSPRING HEALTH, INC.
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Covered Entity Details
Entity Name
DAYSPRING HEALTH, INC.
Subdivision Name
DAYSPRING JELLICO
Type
HRSA-Funded Health Center
340B ID
CH04216A
Entity Address
550 Sunset Trl
Jellico, TN 37762-2343
Grant Number
H80CS00716
Participating Start Date
10/1/1996
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1048
Pharmacy Address
589 HIGHWAY WEST 92
WILLIAMSBURG, KY 40769
Pharmacy Comments
Contract Details
Approval Date
4/8/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark W. Watt, CEO
(423) 784-8492
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/8/2013
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