340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-0816
SCH250057-00 KINGS DAUGHTERS MEDICAL CENTER
Print
Covered Entity Details
Entity Name
KINGS DAUGHTERS MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH250057-00
Entity Address
427 HWY 51 N
BROOKHAVEN, MS 39601
Medicare Provider Number
250057
Participating Start Date
1/1/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0816
Pharmacy Address
960 BROOKWAY BLVD
BROOKHAVEN, MS 39601
Pharmacy Comments
Contract Details
Approval Date
10/5/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/4/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RANDY PIRTLE, CFO
(601) 835-9271
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/5/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session