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WALMART PHARMACY 10-5169
CAH381302-00 SAMARITAN NORTH LINCOLN HOSPITAL
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Covered Entity Details
Entity Name
SAMARITAN NORTH LINCOLN HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381302-00
Entity Address
3043 NE 28TH ST.
LINCOLN CITY, OR 97367
Medicare Provider Number
381302
Participating Start Date
8/3/2010
Last Recertification Date
8/23/2024
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
Daniel Smith, VP Finance/CFO
(541) 768-5390
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/12/2023
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