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WALMART PHARMACY 10-5169
CAH101309-00 Hendry County Hospital Authority DBA Hendry Regional Medical Center
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Covered Entity Details
Entity Name
Hendry County Hospital Authority DBA Hendry Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH101309-00
Entity Address
524 W Sagamore Ave
Clewiston, FL 33440
Medicare Provider Number
101309
Participating Start Date
4/1/2014
Last Recertification Date
8/14/2024
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
7/11/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Troy Eller, CFO
(863) 902-3082
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/11/2023
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