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WAL-MART PHARMACY 10-0153
CAH251337-00 TIPPAH COUNTY HOSPITAL
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Covered Entity Details
Entity Name
TIPPAH COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251337-00
Entity Address
1005 City Ave N
RIPLEY, MS 38663
Medicare Provider Number
251337
Participating Start Date
4/1/2019
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0153
Pharmacy Address
202 PARK PLAZA
NEW ALBANY, MS 38652
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
7/19/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patrick Chapman, CEO
(662) 837-9221
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/15/2022
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