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WALMART PHARMACY 10-5169
CAH451379-00 CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
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Covered Entity Details
Entity Name
CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451379-00
Entity Address
1507 W MAIN ST
GATESVILLE, TX 76528-1024
Medicare Provider Number
451379
Participating Start Date
9/29/2010
Last Recertification Date
8/29/2024
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
Contacts
Covered Entity Signing Official
Kneeley Lawdermilk, CFO
(254) 248-6276
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/17/2023
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