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WALMART PHARMACY 10-5169
SCH450055-00 ROLLING PLAINS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ROLLING PLAINS MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450055-00
Entity Address
200 E. ARIZONA
SWEETWATER, TX 79556
Medicare Provider Number
450055
Participating Start Date
9/8/2010
Last Recertification Date
9/17/2024
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
1/5/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RHONDA GUELKER, CFO
(325) 219-6238
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/16/2023
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