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WALMART PHARMACY 10-5169
CAH451389-00 PECOS COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PECOS COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451389-00
Entity Address
387 W IH-10
FORT STOCKTON, TX 79735
Medicare Provider Number
451389
Participating Start Date
1/1/2019
Last Recertification Date
9/9/2024
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
Betsy Briscoe, CEO
(432) 336-2004 Ext: 4200
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/17/2023
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