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WAL-MART PHARMACY 10-0118
DSH250025 MONROE HEALTH SERVICES INC.
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Covered Entity Details
Entity Name
MONROE HEALTH SERVICES INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250025
Entity Address
1105 EARL FRYE BLVD
AMORY, MS 38821
Medicare Provider Number
250025
Participating Start Date
7/1/2021
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0118
Pharmacy Address
1515 U.S. HWY 278 EAST
AMORY, MS 38821
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRUCE J. TOPPIN, GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY
(662) 377-4229
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/15/2022
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