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WAL-MART PHARMACY 10-0497
DSH180040K UofL Health -- Louisville
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Covered Entity Details
Entity Name
UofL Health -- Louisville
Subdivision Name
Medical Center South
Type
Disproportionate Share Hospital
340B ID
DSH180040K
Entity Address
1903 West Hebron Lane
Shepherdsville, KY 40165
Medicare Provider Number
180040
Outpatient Facility Provider Number
Participating Start Date
4/1/2012
Last Recertification Date
9/13/2020
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0497
Pharmacy Address
500 TAYLORVILLE ROAD
SHELBYVILLE, KY 40065
Pharmacy Comments
Contract Details
Approval Date
9/24/2012
Contract Begin Date
9/24/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/26/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ronald Farr, CFO, Sr. VP
(502) 540-3888
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
9/21/2012
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