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WAL-MART PHARMACY 10-5315
DSH450039 Tarrant County Hospital District d/b/a JPS Health Network
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Covered Entity Details
Entity Name
Tarrant County Hospital District d/b/a JPS Health Network
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450039
Entity Address
1500 S Main Street
FORT WORTH, TX 76104
Medicare Provider Number
450039
Participating Start Date
8/1/1993
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
R. William Whitman, Sr Executive Vice President/Chief Operating Officer
(817) 702-1228
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/16/2018
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