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WAL-MART PHARMACY 10-5315
CAH251338-00 Sharkey Issaquena Community Hospital
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Covered Entity Details
Entity Name
Sharkey Issaquena Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251338-00
Entity Address
19719 Hwy 61
Rolling Fork, MS 39159
Medicare Provider Number
251338
Participating Start Date
7/1/2020
Last Recertification Date
8/17/2023
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
3/2/2022
Contract Begin Date
3/2/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steven Gerald Keever, CEO
(662) 873-4395 Ext: 150
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
3/2/2022
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