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WALMART PHARMACY 10-5169
CAH331314-00 SOLDIERS AND SAILORS MEMORIAL HOSPITAL OF YATES COUNTY
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Covered Entity Details
Entity Name
SOLDIERS AND SAILORS MEMORIAL HOSPITAL OF YATES COUNTY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331314-00
Entity Address
418 NORTH MAIN STREET
PENN YAN, NY 14527
Medicare Provider Number
331314
Participating Start Date
1/1/2020
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
7/15/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Frank Michael Korich, Chief Operating Officer
(315) 787-4021
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/15/2023
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