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WALMART PHARMACY 10-5169
CAH451313-00 FISHER COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
FISHER COUNTY HOSPITAL DISTRICT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451313-00
Entity Address
774 STATE HIGHWAY 70
ROTAN, TX 79546
Medicare Provider Number
451313
Participating Start Date
10/1/2016
Last Recertification Date
8/16/2024
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
Leanne Martinez, CEO
(325) 735-2256 Ext: 284
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/12/2023
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