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WAL-MART PHARMACY 10-5997
CAH251312-00 TYLER HOLMES MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
TYLER HOLMES MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251312-00
Entity Address
409 Tyler Holmes Drive
WINONA, MS 38967
Medicare Provider Number
251312
Participating Start Date
1/1/2018
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
7/19/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cori H Bailey, Administrator
(662) 283-4114 Ext: 6126
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2022
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