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WALMART PHARMACY 10-5169
CAH191326-01 REEVES MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
REEVES MEMORIAL MEDICAL CENTER
Subdivision Name
REEVES MEMORIAL MEDICAL CENTER - Rural Health Clinic
Type
Critical Access Hospital
340B ID
CAH191326-01
Entity Address
402 SECOND STREET
BERNICE, LA 71222-0302
Medicare Provider Number
191326
Outpatient Facility Provider Number
193416
Participating Start Date
1/1/2018
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
4/4/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Matthew Caston, CEO
(318) 285-7762
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/4/2023
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