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WALMART PHARMACY 10-5169
CAH061322-00 Salida Hospital District DBA Heart of the Rockies Regional Medical Center
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Covered Entity Details
Entity Name
Salida Hospital District DBA Heart of the Rockies Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061322-00
Entity Address
1000 Rush Drive
Salida, CO 81201
Medicare Provider Number
061322
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
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lesley Fagerberg, VP Finance
(719) 530-2213
Contract Pharmacy Representative
Walmart
Tisha Campbell, Director of Contracting
(949) 872-4138
Signed By Date
4/11/2023
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