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WAL-MART PHARMACY 10-5315
CAH041308-00 MCGEHEE HOSPITAL INC.
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Covered Entity Details
Entity Name
MCGEHEE HOSPITAL INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041308-00
Entity Address
900 South 3rd
MCGEHEE, AR 71654
Medicare Provider Number
041308
Participating Start Date
10/1/2017
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Terry Lee Amstutz, CEO
(870) 690-4231 Ext: 4231
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/12/2021
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