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WALMART PHARMACY 10-5169
DSH390113 Meadville Medical Center
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Covered Entity Details
Entity Name
Meadville Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390113
Entity Address
751 Liberty Street
Meadville, PA 16335
Medicare Provider Number
390113
Participating Start Date
7/1/2013
Last Recertification Date
8/27/2024
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
4/16/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ellie Jo Amory, 340B Program Administrator
(814) 333-5669
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/16/2023
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