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WALMART PHARMACY 10-5169
DSH250025 MONROE HEALTH SERVICES INC.
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Covered Entity Details
Entity Name
MONROE HEALTH SERVICES INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250025
Entity Address
1105 EARL FRYE BLVD
AMORY, MS 38821
Medicare Provider Number
250025
Participating Start Date
7/1/2021
Last Recertification Date
9/6/2024
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
BRUCE J. TOPPIN, GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY
(662) 377-4229
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/12/2023
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