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WALMART PHARMACY 10-5169
SCH260094-00 COX MEDICAL CENTER BRANSON
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Covered Entity Details
Entity Name
COX MEDICAL CENTER BRANSON
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260094-00
Entity Address
525 Branson Landing Blvd
Branson, MO 65616
Medicare Provider Number
260094
Participating Start Date
7/1/2022
Last Recertification Date
8/23/2024
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
4/19/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jake McWay, SVP - CFO
(417) 269-8811
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
4/19/2023
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