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WAL-MART PHARMACY 10-5315
CAH451310-00 BALLINGER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BALLINGER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451310-00
Entity Address
608 AVENUE B
BALLINGER, TX 76821
Medicare Provider Number
451310
Participating Start Date
9/29/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
4/13/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rhett D. Fricke, CEO/Administrator
(325) 365-2531
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/13/2022
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