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WALMART PHARMACY 10-5169
CAH501336-00 MASON GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MASON GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501336-00
Entity Address
901 Mountain View Drive
SHELTON, WA 98584
Medicare Provider Number
501336
Participating Start Date
4/1/2016
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
Stephen P Leslie, Chief Financial Officer
(360) 432-3260
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/12/2023
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