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WALMART PHARMACY 10-5169
CAH181310-00 CARROLL COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CARROLL COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181310-00
Entity Address
309 11TH STREET
CARROLLTON, KY 41008
Medicare Provider Number
181310
Participating Start Date
10/1/2011
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
4/3/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kimberly Haverly, CEO
(502) 732-3275
Contract Pharmacy Representative
Carroll County Memorial Hospital
Herbert Alfred Hunter, Director of Pharmacy
(502) 732-3207
Signed By Date
4/3/2023
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