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WALMART PHARMACY 10-5169
SCH040047-00 FIVE RIVERS MEDICAL CENTER
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Covered Entity Details
Entity Name
FIVE RIVERS MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH040047-00
Entity Address
2801 MEDICAL CENTER DRIVE
POCAHONTAS, AR 72455
Medicare Provider Number
040047
Participating Start Date
4/1/2021
Last Recertification Date
8/29/2022
Entity Termination Date
10/1/2023
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
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Matt Taylor Nichols, CFO
(870) 892-6204
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/16/2023
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