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WALMART PHARMACY 10-5169
CAH451374-00 Baylor Scott & White Medical Center- Taylor
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Covered Entity Details
Entity Name
Baylor Scott & White Medical Center- Taylor
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451374-00
Entity Address
305 Mallard Ln
Taylor, TX 76574
Medicare Provider Number
451374
Participating Start Date
7/1/2014
Last Recertification Date
8/27/2024
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
1/19/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/19/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tim Tarbell, VP Operations
(512) 654-6297
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/19/2023
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