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WALMART PHARMACY 10-5169
DSH260141 University of Missouri Health Care
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Covered Entity Details
Entity Name
University of Missouri Health Care
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260141
Entity Address
One Hospital Drive
Columbia, MO 65212
Medicare Provider Number
260141
Participating Start Date
12/1/1992
Last Recertification Date
8/16/2024
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
1/18/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Katrina Lambrecht, Chief Operating Officer
(573) 882-6467
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/18/2023
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