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WAL-MART PHARMACY 10-5315
CAH041317-00 DALLAS COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
DALLAS COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041317-00
Entity Address
201 NORTH CLIFTON ST
FORDYCE, AR 71742
Medicare Provider Number
041317
Participating Start Date
8/23/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ken Sanders, Interim Administrator
(870) 352-6363
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/15/2020
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