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WALMART PHARMACY 10-5169
DSH010078 NORTHEAST ALABAMA REGIONAL MED CTR
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Covered Entity Details
Entity Name
NORTHEAST ALABAMA REGIONAL MED CTR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010078
Entity Address
400 EAST TENTH STREET
ANNISTON, AL 36207
Medicare Provider Number
010078
Participating Start Date
1/1/2016
Last Recertification Date
8/19/2024
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
10/14/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mark North, Vice President - Finance/CFO
(256) 741-6370
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/17/2023
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