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WALMART PHARMACY 10-5169
CAH141307-00 PINCKNEYVILLE COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
PINCKNEYVILLE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141307-00
Entity Address
5383 STATE ROUTE 154
PINCKNEYVILLE, IL 62274
Medicare Provider Number
141307
Participating Start Date
1/1/2011
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
Contacts
Covered Entity Signing Official
KARA JO CARSON, CFO
(618) 357-2187 Ext: 5902
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/12/2023
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