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WALMART PHARMACY 10-5169
DSH260061 NEVADA CITY HOSPITAL
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Covered Entity Details
Entity Name
NEVADA CITY HOSPITAL
Subdivision Name
DBA NEVADA REGIONAL MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH260061
Entity Address
800 SOUTH ASH STREET
NEVADA, MO 64772
Medicare Provider Number
260061
Participating Start Date
7/1/2009
Last Recertification Date
9/4/2024
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
Jason Anglin, CEO
(417) 448-3626
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/16/2023
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