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WALMART PHARMACY 10-5169
CAH131307-00 Weiser Valley Hospital District, dba Weiser Memorial Hospital
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Covered Entity Details
Entity Name
Weiser Valley Hospital District, dba Weiser Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131307-00
Entity Address
645 East 5th Street
Weiser, ID 83672
Medicare Provider Number
131307
Participating Start Date
7/1/2013
Last Recertification Date
8/21/2024
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
Contract Termination Date
Termination Reason
8/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Hale, CEO
(208) 549-4450
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/12/2023
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