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WALMART PHARMACY 10-5169
DSH390146 WARREN GENERAL HOSPITAL
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Covered Entity Details
Entity Name
WARREN GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390146
Entity Address
2 CRESCENT PARK WEST
WARREN, PA 16365
Medicare Provider Number
390146
Participating Start Date
1/1/2019
Last Recertification Date
8/16/2024
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
4/4/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathryn E. Carlson, Executive Director of Operations
(814) 723-4973 Ext: 1370
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/4/2023
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