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WALMART PHARMACY 10-5169
CAH381321-00 Grande Ronde Hospital, Inc.
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Covered Entity Details
Entity Name
Grande Ronde Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381321-00
Entity Address
900 Sunset Drive
La Grande, OR 97850
Medicare Provider Number
381321
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
Robert Seymour, CFO/Senior Director of Finance
(541) 963-1463
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/12/2023
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