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WALMART PHARMACY 10-5169
CAH261336-00 IRON COUNTY HOSPITAL
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Covered Entity Details
Entity Name
IRON COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261336-00
Entity Address
301 NORTH HWY 21
PILOT KNOB, MO 63663
Medicare Provider Number
261336
Participating Start Date
10/1/2016
Last Recertification Date
8/27/2024
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
Kayla Chamberlain, CFO
(573) 546-8051
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/12/2023
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