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WAL-MART PHARMACY 10-5315
DSH040067 MAGNOLIA REGIONAL HEALTH SYSTEM INC D/B/A MAGNOLIA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
MAGNOLIA REGIONAL HEALTH SYSTEM INC D/B/A MAGNOLIA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040067
Entity Address
101 HOSPITAL DRIVE
MAGNOLIA, AR 71753
Medicare Provider Number
040067
Participating Start Date
10/1/2016
Last Recertification Date
8/15/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Rex Jones, CEO
(870) 235-3212
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/13/2020
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