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WALMART PHARMACY 10-5169
DSH190025 SAVOY MEDICAL MANAGEMENT GROUP, INC. D/B/A SAVOY MEDICAL CENTER
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Covered Entity Details
Entity Name
SAVOY MEDICAL MANAGEMENT GROUP, INC. D/B/A SAVOY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190025
Entity Address
801 POINCIANA AVENUE
MAMOU, LA 70554
Medicare Provider Number
190025
Participating Start Date
7/1/2010
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
6/1/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LANCE ARMENTOR, CEO
(337) 468-0350
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
6/1/2023
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