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WALMART PHARMACY 10-4453
DSH450352 Hunt Regional Medical Center
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Covered Entity Details
Entity Name
Hunt Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450352
Entity Address
4215 Joe Ramsey Blvd
Greenville, TX 75401
Medicare Provider Number
450352
Participating Start Date
1/1/2013
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4453
Pharmacy Address
4715 WESLEY ST.
GREENVILLE, TX 75401
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
James Ayers Robertson, Chief Financial Officer
(903) 408-1607
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/15/2022
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