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WALMART PHARMACY 10-5169
CAH451331-00 COON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
COON MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451331-00
Entity Address
1411 DENVER AVE
DALHART, TX 79022
Medicare Provider Number
451331
Participating Start Date
4/1/2011
Last Recertification Date
8/30/2024
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
Kacey Schniederjan, CEO
(806) 244-9276
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/16/2023
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