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WAL-MART PHARMACY 10-4238
DSH050192 Reedley Community Hospital dba Adventist Health Reedley
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Covered Entity Details
Entity Name
Reedley Community Hospital dba Adventist Health Reedley
Subdivision Name
Reedley Community Hospital
Type
Disproportionate Share Hospital
340B ID
DSH050192
Entity Address
372 W. Cypress Ave
Reedley, CA 93654
Medicare Provider Number
050192
Participating Start Date
10/1/2013
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4238
Pharmacy Address
2761 JENSEN AVE
SANGER, CA 93657
Pharmacy Comments
Contract Details
Approval Date
1/10/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David L. Larsen, SR VP CFO
(559) 537-0050
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/10/2014
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