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WALMART PHARMACY 10-5169
DSH050057 Kaweah Delta Health Care District DBA Kaweah Health
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Covered Entity Details
Entity Name
Kaweah Delta Health Care District DBA Kaweah Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050057
Entity Address
400 West Mineral King Avenue
Visalia, CA 93291
Medicare Provider Number
050057
Participating Start Date
7/1/2004
Last Recertification Date
8/22/2024
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
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary K Herbst, Chief Executive Officer
(559) 624-2330
Contract Pharmacy Representative
Walmart
Tisha Campbell, Director of Contracting
(949) 872-4138
Signed By Date
4/12/2023
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