340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALMART PHARMACY 10-5169
CAH141338-00 Memorial Hospital
Print
Covered Entity Details
Entity Name
Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141338-00
Entity Address
1900 State Street
Chester, IL 62233
Medicare Provider Number
141338
Participating Start Date
4/1/2012
Last Recertification Date
8/14/2024
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
4/13/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brett Bollmann, Chief Executive Officer
(618) 826-4581 Ext: 1298
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/13/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session