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WAL-MART PHARMACY 10-1983
DSH050067 OAK VALLEY DISTRICT HOSPITAL
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Covered Entity Details
Entity Name
OAK VALLEY DISTRICT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050067
Entity Address
350 SOUTH OAK STREET
OAKDALE, CA 95361
Medicare Provider Number
050067
Participating Start Date
4/1/2016
Last Recertification Date
8/21/2023
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1983
Pharmacy Address
3960 MITCHELL RD
CERES, CA 95307
Pharmacy Comments
Contract Details
Approval Date
4/13/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
John McCormick, President and CEO
(209) 848-4102
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/13/2017
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