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WALMART PHARMACY 10-5169
CAH231311-00 Deckerville Community Hospital. Inc.
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Covered Entity Details
Entity Name
Deckerville Community Hospital. Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231311-00
Entity Address
3559 Pine St
Deckerville, MI 48427
Medicare Provider Number
231311
Participating Start Date
1/1/2014
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
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Gentner, Director of Finance
(810) 376-7024
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/14/2023
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