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WALMART PHARMACY 10-5169
CAH451342-00 MITCHELL COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
MITCHELL COUNTY HOSPITAL DISTRICT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451342-00
Entity Address
997 WEST IH 20
COLORADO CITY, TX 79512
Medicare Provider Number
451342
Participating Start Date
7/1/2011
Last Recertification Date
8/13/2024
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
4/6/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michelle Gafford, CEO
(325) 728-3431 Ext: 7552
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/6/2023
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