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WALMART PHARMACY 10-5169
CAH451384-00 D.M. COGDELL MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
D.M. COGDELL MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451384-00
Entity Address
1700 COGDELL BLVD
SNYDER, TX 79549
Medicare Provider Number
451384
Participating Start Date
10/1/2016
Last Recertification Date
8/14/2024
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
1/14/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John H. Everett, COO
(325) 574-7439
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/14/2023
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