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WAL-MART PHARMACY 10-1124
RRC010039-00 HUNTSVILLE HOSPITAL
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Covered Entity Details
Entity Name
HUNTSVILLE HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC010039-00
Entity Address
101 SIVLEY ROAD SW
HUNTSVILLE, AL 35801
Medicare Provider Number
010039
Participating Start Date
12/1/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1124
Pharmacy Address
1201 HIGHWAY 31, N.W.
HARTSELLE, AL 35640
Pharmacy Comments
Contract Details
Approval Date
1/7/2022
Contract Begin Date
1/18/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clinton Carter, CFO
(256) 265-8818
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/7/2022
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