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WALMART PHARMACY 10-5169
CAH171379-00 MORRIS COUNTY HOSPITAL
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Covered Entity Details
Entity Name
MORRIS COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171379-00
Entity Address
600 N. WASHINGTON STREET
COUNCIL GROVE, KS 66846
Medicare Provider Number
171379
Participating Start Date
9/30/2010
Last Recertification Date
8/19/2024
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
4/5/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RON CHRISTENSON, CHIEF FINANCIAL OFFICER
(620) 767-6811 Ext: 120
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/5/2023
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