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WALMART PHARMACY 10-5169
DSH160058 UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160058
Entity Address
200 HAWKINS DRIVE
IOWA CITY, IA 52242
Medicare Provider Number
160058
Participating Start Date
10/1/1999
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
7/13/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/20/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Brownlee, Chief Pharmacy Officer
(319) 384-9371
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/13/2023
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