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ECONO-MED OF WALNUT RIDGE
CAH041309-00 LAWRENCE MEMORIAL HEALTH FOUNDATION, INC
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Covered Entity Details
Entity Name
LAWRENCE MEMORIAL HEALTH FOUNDATION, INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041309-00
Entity Address
1309 W MAIN ST
WALNUT RIDGE, AR 72476-1430
Medicare Provider Number
041309
Participating Start Date
4/1/2015
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
ECONO-MED OF WALNUT RIDGE
Pharmacy Address
1045 W MAIN ST STE B
WALNUT RIDGE, AR 72476
Pharmacy Comments
Contract Details
Approval Date
1/12/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joshua T. Conlee, President
(870) 886-1266
Contract Pharmacy Representative
Econo-Med of Walnut Ridge
Greta Ishmael, Pharmacist
(870) 856-4696
Signed By Date
1/12/2022
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