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WALMART PHARMACY 10-5169
SCH490018-00 AUGUSTA MEDICAL CENTER
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Covered Entity Details
Entity Name
AUGUSTA MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH490018-00
Entity Address
78 MEDICAL CENTER DRIVE
FISHERSVILLE, VA 22939
Medicare Provider Number
490018
Participating Start Date
7/1/2020
Last Recertification Date
9/9/2024
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
Contract Termination Date
Termination Reason
10/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Scott Crabtree, Vice President of Professional Services
(540) 332-4800
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/5/2023
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