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WALMART PHARMACY 10-5169
CAH031319-00 MT. GRAHAM REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
MT. GRAHAM REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031319-00
Entity Address
1600 S 20th Avenue
SAFFORD, AZ 85546
Medicare Provider Number
031319
Participating Start Date
1/1/2023
Last Recertification Date
8/19/2024
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
Kathleen Louise Williams, VP of Finance / Chief Financial Officer
(928) 348-4060
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/11/2023
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