340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-5315
CAH231315-00 ASCENSION BORGESS-LEE HOSPITAL
Print
Covered Entity Details
Entity Name
ASCENSION BORGESS-LEE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231315-00
Entity Address
420 WEST HIGH STREET
DOWAGIAC, MI 49047
Medicare Provider Number
231315
Participating Start Date
9/30/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/13/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Ryder, COO
(269) 783-3082
Contract Pharmacy Representative
Wal-Mart
Jodi Prohofsky, Sr. Director, Payer Relations
(254) 301-6601
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