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WAL-MART PHARMACY 10-0036
RRC040039-00 Arkansas Methodist Medical Center
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Covered Entity Details
Entity Name
Arkansas Methodist Medical Center
Subdivision Name
Type
Rural Referral Center
340B ID
RRC040039-00
Entity Address
900 W Kingshighway
Paragould, AR 72450
Medicare Provider Number
040039
Participating Start Date
4/1/2018
Last Recertification Date
8/22/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0036
Pharmacy Address
2802 WEST KINGS HIGHWAY
PARAGOULD, AR 72450
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brad Bloemer, CFO
(870) 239-7102
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/14/2020
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