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WALMART PHARMACY 10-5169
SCH450370-00 COLUMBUS COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
COLUMBUS COMMUNITY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450370-00
Entity Address
110 SHULT DRIVE
COLUMBUS, TX 78934
Medicare Provider Number
450370
Participating Start Date
1/1/2015
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
4/5/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Vanek, CEO
(979) 493-7561
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/5/2023
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