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WALMART PHARMACY 10-5169
CAH241357-00 FIRST CARE MEDICAL SERVICES
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Covered Entity Details
Entity Name
FIRST CARE MEDICAL SERVICES
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241357-00
Entity Address
900 HILLIGOSS BLVD SE
FOSSTON, MN 56542
Medicare Provider Number
241357
Participating Start Date
4/1/2011
Last Recertification Date
9/3/2024
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
7/6/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kimberly Bodensteiner, CFO
(218) 435-7633
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/6/2023
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