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WALMART PHARMACY 10-5169
CAH141344-00 LAWRENCE COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
LAWRENCE COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141344-00
Entity Address
2200 STATE STREET
LAWRENCEVILLE, IL 62439
Medicare Provider Number
141344
Participating Start Date
1/1/2016
Last Recertification Date
8/29/2024
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
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carl H Aten, Board Chairman
(618) 843-8424
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/12/2023
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