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WAL-MART PHARMACY 10-2044
DSH050039 ENLOE MEDICAL CENTER
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Covered Entity Details
Entity Name
ENLOE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050039
Entity Address
1531 ESPLANADE
CHICO, CA 95926
Medicare Provider Number
050039
Participating Start Date
1/1/2017
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2044
Pharmacy Address
2044 FOREST AVENUE
CHICO, CA 95928
Pharmacy Comments
Contract Details
Approval Date
7/13/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/5/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Myron Machula, VP/CFO
(530) 332-7357
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/13/2015
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