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WALMART PHARMACY 10-5169
CAH041317-00 DALLAS COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
DALLAS COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041317-00
Entity Address
201 NORTH CLIFTON ST
FORDYCE, AR 71742
Medicare Provider Number
041317
Participating Start Date
8/23/2010
Last Recertification Date
8/20/2024
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
David Mantz, Administrator
(870) 352-6300 Ext: 371
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/14/2023
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