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WAL-MART PHARMACY 10-3331
CAH041326-00 DELTA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DELTA MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041326-00
Entity Address
811 HWY 65 SOUTH
DUMAS, AR 71639
Medicare Provider Number
041326
Participating Start Date
1/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3331
Pharmacy Address
5501 SOUTH OLIVE ST
PINE BLUFF, AR 71603
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeremy D Capps, CEO
(870) 382-8126
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/13/2023
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