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WALMART PHARMACY 10-5169
CAH171311-00 ROOKS COUNTY HEALTH CENTER
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Covered Entity Details
Entity Name
ROOKS COUNTY HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171311-00
Entity Address
1210 N. WASHINGTON
PLAINVILLE, KS 67663
Medicare Provider Number
171311
Participating Start Date
1/1/2019
Last Recertification Date
8/14/2024
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
2/3/2023
Contract Begin Date
2/6/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephanie Bjornstad, Special Projects Manager
(785) 434-4553 Ext: 433
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
2/3/2023
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