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WAL-MART PHARMACY 10-0345
RRC450102-00 CHRISTUS MOTHER FRANCES HOSP-TYLER
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Covered Entity Details
Entity Name
CHRISTUS MOTHER FRANCES HOSP-TYLER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC450102-00
Entity Address
800 EAST DAWSON ST.
TYLER, TX 75701
Medicare Provider Number
450102
Participating Start Date
8/13/2020
Last Recertification Date
8/20/2021
Entity Termination Date
3/10/2022
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0345
Pharmacy Address
2223 SOUTH LOOP 256
PALESTINE, TX 75801
Pharmacy Comments
Contract Details
Approval Date
10/7/2020
Contract Begin Date
10/14/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/10/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Elizabeth Pulliam, Chief Financial Officer
(903) 606-4102
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/7/2020
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