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WALMART PHARMACY 10-5169
CAH151319-00 Gibson General Hospital, Inc
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Covered Entity Details
Entity Name
Gibson General Hospital, Inc
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151319-00
Entity Address
1808 Sherman Drive
Princeton, IN 47670
Medicare Provider Number
151319
Participating Start Date
1/1/2012
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
Lois A Morgan, Chief Administrative Officer
(812) 385-9237
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/10/2023
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