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WALMART PHARMACY 10-5169
CAH201308-00 HOULTON REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
HOULTON REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201308-00
Entity Address
20 HARTFORD STREET
HOULTON, ME 04730
Medicare Provider Number
201308
Participating Start Date
9/15/2010
Last Recertification Date
8/16/2024
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
CYNTHIA THOMPSON, CFO
(207) 532-2900 Ext: 2142
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/17/2023
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