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WALMART PHARMACY 10-5169
DSH220024 HOLYOKE MEDICAL CENTER
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Covered Entity Details
Entity Name
HOLYOKE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220024
Entity Address
575 BEECH STREET
HOLYOKE, MA 01040
Medicare Provider Number
220024
Participating Start Date
10/1/2004
Last Recertification Date
8/20/2024
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
SPIROS HATIRAS, CEO
(413) 534-2667
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
4/5/2023
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