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WALMART PHARMACY 10-5169
SCH370022-00 JACKSON COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
JACKSON COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH370022-00
Entity Address
1200 EAST PECAN
ALTUS, OK 73521
Medicare Provider Number
370022
Participating Start Date
9/27/2010
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
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shelley Simmons, VP of Patient Care
(580) 379-5533
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/17/2023
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