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WAL-MART PHARMACY 10-0927
CAH451337-00 Lockney General Hospital District
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Covered Entity Details
Entity Name
Lockney General Hospital District
Subdivision Name
dba W.J. Mangold Memorial Hospital
Type
Critical Access Hospital
340B ID
CAH451337-00
Entity Address
320 N. Main
Lockney, TX 79241
Medicare Provider Number
451337
Participating Start Date
1/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0927
Pharmacy Address
1501 NORTH I-27
PLAINVIEW, TX 79072
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James F Heitzenrater, CEO
(806) 652-3373
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/11/2019
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