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WAL-MART PHARMACY 10-0067
DSH040015 MENA REGIONAL HEALTH SYSTEM
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Covered Entity Details
Entity Name
MENA REGIONAL HEALTH SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040015
Entity Address
311 NORTH MORROW
MENA, AR 71953
Medicare Provider Number
040015
Participating Start Date
7/1/2010
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0067
Pharmacy Address
600 HIGHWAY 71 NORTH
MENA, AR 71953
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
4/21/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jay Quebedeaux, CEO
(479) 394-6100 Ext: 2237
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/13/2020
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