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WAL-MART PHARMACY 10-0248
CAH451303-02 LIMESTONE MEDICAL CENTER
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Covered Entity Details
Entity Name
LIMESTONE MEDICAL CENTER
Subdivision Name
Family Medicine Center - Family Medicine Center
Type
Critical Access Hospital
340B ID
CAH451303-02
Entity Address
801 McClintic Drive
Groesbeck, TX 76642
Medicare Provider Number
451303
Outpatient Facility Provider Number
453984
Participating Start Date
7/1/2019
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0248
Pharmacy Address
1406 E. MILAM
MEXIA, TX 76667
Pharmacy Comments
Contract Details
Approval Date
5/24/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Larry N. Price, CEO/ADMINISTRATOR
(254) 729-3281 Ext: 2100
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/30/2019
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