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WALMART PHARMACY 10-5169
SCH260186-00 Lake Regional Health System
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Covered Entity Details
Entity Name
Lake Regional Health System
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260186-00
Entity Address
54 HOSPITAL DR
Osage Beach, MO 65065-3050
Medicare Provider Number
260186
Participating Start Date
1/1/2017
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
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Henry Zeisel, Executive Vice President Finance/CFO
(573) 348-8388
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/14/2023
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