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WALMART PHARMACY 10-5169
CAH501327-00 Whitman Hospital and Medical Center
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Covered Entity Details
Entity Name
Whitman Hospital and Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501327-00
Entity Address
1200 West Fairview
Colfax, WA 99111
Medicare Provider Number
501327
Participating Start Date
7/1/2012
Last Recertification Date
8/19/2024
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
10/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Abby Smith, Chief Financial Officer
(509) 397-3435 Ext: 312
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/13/2023
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