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WALMART PHARMACY #10-6190
CAH101309-01 Hendry County Hospital Authority DBA Hendry Regional Medical Center
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Covered Entity Details
Entity Name
Hendry County Hospital Authority DBA Hendry Regional Medical Center
Subdivision Name
Hendry Family Care Center
Type
Critical Access Hospital
340B ID
CAH101309-01
Entity Address
500 W Sagamore Ave
Clewiston, FL 33440
Medicare Provider Number
101309
Outpatient Facility Provider Number
103422
Participating Start Date
4/1/2014
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY #10-6190
Pharmacy Address
1951 W HICKPOCHEE AVE
LABELLE, FL 33935
Pharmacy Comments
Contract Details
Approval Date
4/1/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Beltz, CFO
(863) 902-3082
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/1/2020
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