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WAL-MART PHARMACY 10-0289
CAH041326-00 DELTA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DELTA MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041326-00
Entity Address
811 HWY 65 SOUTH
DUMAS, AR 71639
Medicare Provider Number
041326
Participating Start Date
1/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0289
Pharmacy Address
1001 HIGHWAY 65 S
MC GEHEE, AR 71654
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ashley nicole anthony, ceo
(870) 382-4303
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/15/2019
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