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WALMART PHARMACY 10-5169
DSH450424 Houston Methodist Baytown Hospital
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Covered Entity Details
Entity Name
Houston Methodist Baytown Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450424
Entity Address
4401 GARTH ROAD
BAYTOWN, TX 77521-2122
Medicare Provider Number
450424
Participating Start Date
4/1/2009
Last Recertification Date
8/21/2024
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
Contract Termination Date
Termination Reason
10/13/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Becky P Chalupa, Vice President / Chief Nursing Officer
(281) 420-8602
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/4/2023
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