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WALMART PHARMACY 10-5169
CAH041323-00 ASHLEY COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
ASHLEY COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041323-00
Entity Address
1015 UNITY ROAD
CROSSETT, AR 71635
Medicare Provider Number
041323
Participating Start Date
1/1/2011
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
PHILLIP GILMORE, CHIEF EXECUTIVE OFFICER
(870) 364-4111 Ext: 271
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/14/2023
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