340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-5422
DSH110132 MEMORIAL HOSPITAL AND MANOR
Print
Covered Entity Details
Entity Name
MEMORIAL HOSPITAL AND MANOR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110132
Entity Address
1500 E SHOTWELL STREET
BAINBRIDGE, GA 39819
Medicare Provider Number
110132
Participating Start Date
10/1/2004
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5422
Pharmacy Address
500 EAST ALICE STREET
BAINBRIDGE, GA 39819
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregg William Magers, Interim CEO
(229) 243-6109
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/12/2017
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