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WAL-MART PHARMACY 10-0258
CAH251302-00 BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251302-00
Entity Address
400 SOUTH CHESTNUT ST
ABERDEEN, MS 39730
Medicare Provider Number
251302
Participating Start Date
9/24/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0258
Pharmacy Address
3929 N GLOSTER ST
TUPELO, MS 38804
Pharmacy Comments
Contract Details
Approval Date
4/2/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Chris Chandler, CEO
(662) 369-2455
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/2/2021
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