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WAL-MART PHARMACY 10-0068
CAH041307-00 ST BERNARDS COMMUNITY HOSPITAL DBA CROSSRIDGE COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
ST BERNARDS COMMUNITY HOSPITAL DBA CROSSRIDGE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041307-00
Entity Address
310 S FALLS BLVD
WYNNE, AR 72396
Medicare Provider Number
041307
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0068
Pharmacy Address
800 HWY 64 EAST
WYNNE, AR 72396
Pharmacy Comments
Contract Details
Approval Date
7/13/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GARY SPARKS, ADMINISTRATOR
(870) 208-2108
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/13/2021
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