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WALMART PHARMACY 10-5169
CAH201302-00 Lincoln Hospital
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Covered Entity Details
Entity Name
Lincoln Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201302-00
Entity Address
35 Miles Street
Damariscotta, ME 04543-4047
Medicare Provider Number
201302
Participating Start Date
4/1/2014
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
7/9/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/11/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Wayne R Printy, CFO
(207) 563-4476
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/9/2023
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