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WALMART PHARMACY 10-5169
DSH380022 SAMARITAN ALBANY GENERAL HOSPITAL
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Covered Entity Details
Entity Name
SAMARITAN ALBANY GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380022
Entity Address
1046 6TH AVE SW
ALBANY, OR 97321
Medicare Provider Number
380022
Participating Start Date
4/1/2012
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
4/13/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DANIEL B. SMITH, VP FINANCE/CFO
(541) 768-5390
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/13/2023
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