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WALMART PHARMACY 10-5169
CAH321305-00 NOR-LEA GENERAL HOSPITAL
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Covered Entity Details
Entity Name
NOR-LEA GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH321305-00
Entity Address
1600 N. MAIN AVE
LOVINGTON, NM 88260
Medicare Provider Number
321305
Participating Start Date
9/24/2010
Last Recertification Date
8/19/2024
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
Contract Termination Date
Termination Reason
1/5/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ALLYSON ROBERTS, CFO
(575) 396-6611 Ext: 1126
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/12/2023
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