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WALMART PHARMACY 10-5169
CAH251312-00 TYLER HOLMES MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
TYLER HOLMES MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251312-00
Entity Address
409 Tyler Holmes Drive
WINONA, MS 38967
Medicare Provider Number
251312
Participating Start Date
1/1/2018
Last Recertification Date
8/16/2024
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
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cori H Bailey, Administrator
(662) 283-4114 Ext: 6126
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/11/2023
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