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WALMART PHARMACY 10-5169
CAH201309-00 MRH Corp. DBA Northern Light Mayo Hospital
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Covered Entity Details
Entity Name
MRH Corp. DBA Northern Light Mayo Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201309-00
Entity Address
897 WEST MAIN STREET
DOVER FOXCROFT, ME 04426-1029
Medicare Provider Number
201309
Participating Start Date
9/22/2010
Last Recertification Date
8/27/2024
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
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer Goodrich, Vice President of Finance
(207) 316-7189
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/17/2023
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