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WALMART PHARMACY 10-5169
CAH451303-00 LIMESTONE MEDICAL CENTER
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Covered Entity Details
Entity Name
LIMESTONE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451303-00
Entity Address
701 MCCLINTIC DR
GROESBECK, TX 76642
Medicare Provider Number
451303
Participating Start Date
7/1/2019
Last Recertification Date
8/15/2024
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
4/24/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Larry N. Price, CEO/ADMINISTRATOR
(254) 729-3281 Ext: 2100
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/24/2023
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