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WALMART PHARMACY 10-5169
SCH110071-00 Appling General Hospital
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Covered Entity Details
Entity Name
Appling General Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH110071-00
Entity Address
163 E Tollison Street
Baxley, GA 31513
Medicare Provider Number
110071
Participating Start Date
1/1/2014
Last Recertification Date
8/16/2024
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
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrea Pierce, CEO
(912) 367-9841 Ext: 1230
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
4/17/2023
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