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WALMART PHARMACY 10-5169
CAH141300-00 THOMAS H BOYD CRITICAL ACC HOSPITAL
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Covered Entity Details
Entity Name
THOMAS H BOYD CRITICAL ACC HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141300-00
Entity Address
800 SCHOOL STREET
CARROLLTON, IL 62016
Medicare Provider Number
141300
Participating Start Date
10/1/2018
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
7/5/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donna Dewitt, CEO
(217) 942-6946 Ext: 1201
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/5/2023
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