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WALMART PHARMACY 10-5169
DSH440007 UNITY MEDICAL CENTER
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Covered Entity Details
Entity Name
UNITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440007
Entity Address
481 INTERSTATE DRIVE
MANCHESTER, TN 37355
Medicare Provider Number
440007
Participating Start Date
10/1/2019
Last Recertification Date
8/12/2024
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
Martha Henley, Chief Executive Officer
(931) 450-1701
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/3/2023
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