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WALMART PHARMACY 10-5169
CAH261332-00 Carroll County Memorial Hospital
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Covered Entity Details
Entity Name
Carroll County Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261332-00
Entity Address
1502 N Jefferson
Carrollton, MO 64633
Medicare Provider Number
261332
Participating Start Date
4/1/2013
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
4/10/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles Blake Riley, Chief Operations Officer
(660) 542-1695 Ext: 3972
Contract Pharmacy Representative
Carroll County Memorial Hospital
Charles Blake Riley, Chief Operations Officer
(660) 542-1695 Ext: 3972
Signed By Date
4/10/2023
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