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WALMART PHARMACY 10-5169
CH062090 MID-DELTA HEALTH SYSTEMS INC
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Covered Entity Details
Entity Name
MID-DELTA HEALTH SYSTEMS INC
Subdivision Name
Mid Delta Health Center
Type
HRSA-Funded Health Center
340B ID
CH062090
Entity Address
245 Madison St
Clarendon, AR 72029-2706
Grant Number
H80CS17147
Participating Start Date
10/1/2006
Last Recertification Date
2/25/2025
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
MONICA L LINDLEY, CEO
(870) 672-1527 Ext: 8706721527
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/17/2023
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