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WALMART PHARMACY 10-5169
CHC06642-01 WESTERN MARYLAND HEALTH CARE CORPORATION
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Covered Entity Details
Entity Name
WESTERN MARYLAND HEALTH CARE CORPORATION
Subdivision Name
Mountain Laurel Medical Center Grantsville
Type
HRSA-Funded Health Center
340B ID
CHC06642-01
Entity Address
104 PARKVIEW DR
GRANTSVILLE, MD 21536-1086
Grant Number
H80CS06642
Participating Start Date
7/1/2016
Last Recertification Date
2/10/2025
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
4/7/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Drew Pierce, Chief Financial Officer
(301) 533-3300 Ext: 3018
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/7/2023
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