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WALMART PHARMACY 10-5169
DSH050367 NorthBay Healthcare Group
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Covered Entity Details
Entity Name
NorthBay Healthcare Group
Subdivision Name
NORTH BAY MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH050367
Entity Address
1200 B GALE WILSON BLVD
FAIRFIELD, CA 94533
Medicare Provider Number
050367
Participating Start Date
7/1/2005
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
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tim Maurice, CFO
(707) 646-3424
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/13/2023
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