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WAL-MART PHARMACY 10-1530
CAH251318-00 NORTH SUNFLOWER MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTH SUNFLOWER MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251318-00
Entity Address
840 NORTH OAK AVENUE
RULEVILLE, MS 38771
Medicare Provider Number
251318
Participating Start Date
9/16/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1530
Pharmacy Address
710 N DAVIS AVENUE
CLEVELAND, MS 38732
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sam Miller, Chief Executive Officer
(662) 721-0186
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/15/2021
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