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WAL-MART PHARMACY 10-1661
DSH340040 PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340040
Entity Address
2100 STANTONSBURG RD
GREENVILLE, NC 27834
Medicare Provider Number
340040
Participating Start Date
4/1/2003
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1661
Pharmacy Address
4101 W. VERNON AVE
KINSTON, NC 28504-9672
Pharmacy Comments
Contract Details
Approval Date
4/20/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Floyd, PRESIDENT
(252) 847-5949
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/20/2018
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