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WALMART PHARMACY 10-5169
CAH031302-00 NORTHERN COCHISE COMMUNITY HOSPITAL, INC.
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Covered Entity Details
Entity Name
NORTHERN COCHISE COMMUNITY HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031302-00
Entity Address
901 WEST REX ALLEN DRIVE
WILLCOX, AZ 85643
Medicare Provider Number
031302
Participating Start Date
8/5/2010
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
1/6/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mo Sheldon, CEO
(520) 766-6465
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/6/2023
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