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WALMART PHARMACY 10-5169
CAH371303-00 ROGER MILLS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ROGER MILLS MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371303-00
Entity Address
501 SOUTH LL MALES AVENUE
CHEYENNE, OK 73628
Medicare Provider Number
371303
Participating Start Date
7/1/2017
Last Recertification Date
8/29/2024
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
Contract Termination Date
Termination Reason
8/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Cynthia E Duncan, CEO
(580) 497-3336 Ext: 224
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/13/2023
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