340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-0938
RRC010024-00 JACKSON HOSPITAL AND CLINIC INC
Print
Covered Entity Details
Entity Name
JACKSON HOSPITAL AND CLINIC INC
Subdivision Name
Type
Rural Referral Center
340B ID
RRC010024-00
Entity Address
1725 PINE STREET
MONTGOMERY, AL 36106-1109
Medicare Provider Number
010024
Participating Start Date
4/1/2017
Last Recertification Date
9/6/2022
Entity Termination Date
9/7/2022
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0938
Pharmacy Address
6495 ATLANTA HIGHWAY
MONTGOMERY (E), AL 36117
Pharmacy Comments
Contract Details
Approval Date
1/8/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/7/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joe Riley, CEO
(334) 293-8809
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/8/2018
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