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WALMART PHARMACY 10-5169
DSH180051 JENNIE STUART MEDICAL CENTER
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Covered Entity Details
Entity Name
JENNIE STUART MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180051
Entity Address
320 WEST 18TH STREET
HOPKINSVILLE, KY 42240
Medicare Provider Number
180051
Participating Start Date
9/2/2008
Last Recertification Date
8/13/2024
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
7/13/2023
Contract Begin Date
7/13/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Beth McCraw, VP Nursing Services
(270) 887-0100 Ext: 1463
Contract Pharmacy Representative
Jennie Stuart Medical Center
Angela N Bradt, PharmD
(270) 887-0166
Signed By Date
7/13/2023
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