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WALMART PHARMACY 10-5169
CAH141345-00 Salem Township Hospital
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Covered Entity Details
Entity Name
Salem Township Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141345-00
Entity Address
1201 Ricker Drive
Salem, IL 62881
Medicare Provider Number
141345
Participating Start Date
4/1/2013
Last Recertification Date
8/20/2024
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
1/12/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alexander Nazarian, CEO
(618) 740-1647
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/12/2023
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