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WALMART PHARMACY 10-5169
CAH261313-00 Macon County Samaritan Memorial Hospital
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Covered Entity Details
Entity Name
Macon County Samaritan Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261313-00
Entity Address
1205 N. Missouri St.
Macon, MO 63552
Medicare Provider Number
261313
Participating Start Date
10/1/2012
Last Recertification Date
8/22/2024
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
Jill Williams, CEO
(660) 385-8716
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/4/2023
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