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WALMART PHARMACY 10-5169
CAH141331-00 MARSHALL BROWNING HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
MARSHALL BROWNING HOSPITAL ASSOCIATION
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141331-00
Entity Address
900 NORTH WASHINGTON STREET
DU QUOIN, IL 62832
Medicare Provider Number
141331
Participating Start Date
10/1/2016
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
1/18/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Harold Calderon, CFO
(618) 542-2146 Ext: 1420
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/18/2023
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