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WALMART PHARMACY 10-5169
DSH180044 PIKEVILLE MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
PIKEVILLE MEDICAL CENTER, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180044
Entity Address
911 BYPASS ROAD
PIKEVILLE, KY 41501
Medicare Provider Number
180044
Participating Start Date
1/1/2007
Last Recertification Date
8/13/2024
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
MICHELLE HAGY, CFO
(606) 430-3519
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/12/2023
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