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WALMART PHARMACY 10-5169
SCH460019-00 Uintah Basin Medical Center
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Covered Entity Details
Entity Name
Uintah Basin Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH460019-00
Entity Address
250 West 300 North
Roosevelt, UT 84066
Medicare Provider Number
460019
Participating Start Date
7/1/2012
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
Brent Hales, CFO
(435) 722-6164
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/6/2023
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