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WAL-MART CENTRAL FILL 10-2670
SCH420053-00 NEWBERRY COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
NEWBERRY COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH420053-00
Entity Address
2669 KINARD ST
NEWBERRY, SC 29108
Medicare Provider Number
420053
Participating Start Date
10/1/2011
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
1/9/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/28/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DEBRA ROBERTS, CHIEF OPERATING OFFICER
(803) 405-7161
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/9/2017
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