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WALMART PHARMACY 10-5169
CAH491307-00 PAGE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PAGE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491307-00
Entity Address
200 MEMORIAL DRIVE
LURAY, VA 22835
Medicare Provider Number
491307
Participating Start Date
9/22/2010
Last Recertification Date
8/23/2024
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
Contacts
Covered Entity Signing Official
Peter F. Gallagher, CFO
(540) 536-8031
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/16/2023
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