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WALMART PHARMACY 10-7238
DSH340186 VIDANT BEAUFORT HOSPITAL
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Covered Entity Details
Entity Name
VIDANT BEAUFORT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340186
Entity Address
628 E. 12TH STREET
WASHINGTON, NC 27889
Medicare Provider Number
340186
Participating Start Date
7/1/2021
Last Recertification Date
8/30/2021
Entity Termination Date
1/1/2022
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-7238
Pharmacy Address
11233B NC 55 HWY
GRANTSBORO, NC 28529
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/28/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
LUCINDA CRAWFORD, VICE PRESIDENT OF FINANCIAL SERVICES
(910) 296-2608
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/16/2018
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