340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALMART PHARMACY 10-5169
DSH450565 Palo Pinto General Hospital
Print
Covered Entity Details
Entity Name
Palo Pinto General Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450565
Entity Address
400 SW 25th Avenue
Mineral Wells, TX 76067-8246
Medicare Provider Number
450565
Participating Start Date
10/1/2011
Last Recertification Date
9/13/2024
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
1/17/2023
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
Ross Korkmas, CEO
(940) 325-7891 Ext: 6400
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/17/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session