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WALMART PHARMACY 10-5169
DSH450155 DEAF SMITH COUNTY HOSPITAL DISTRICT DBA HEREFORD REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
DEAF SMITH COUNTY HOSPITAL DISTRICT DBA HEREFORD REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450155
Entity Address
540 West 15th Street
HEREFORD, TX 79045
Medicare Provider Number
450155
Participating Start Date
10/1/2004
Last Recertification Date
8/27/2024
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
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/9/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Gafford, CFO
(806) 349-9233
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/16/2023
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