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WALMART PHARMACY 10-5169
CAH521308-00 AMERY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
AMERY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521308-00
Entity Address
265 E GRIFFIN ST
AMERY, WI 54001
Medicare Provider Number
521308
Participating Start Date
9/20/2010
Last Recertification Date
8/19/2024
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
7/10/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/16/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Doug Edward Johnson, VP/CFO
(715) 243-2852
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
7/10/2023
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