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WALMART PHARMACY 10-5169
CH04798G DR. ARENIA C. MALLORY COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
DR. ARENIA C. MALLORY COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Mallory Mobile RV Clinic
Type
HRSA-Funded Health Center
340B ID
CH04798G
Entity Address
17280 Highway 17
Lexington, MS 39095-6614
Grant Number
H80CS00580
Participating Start Date
7/1/2023
Last Recertification Date
2/11/2025
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
7/19/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clyde Rozell Chapman, CEO
(662) 834-2566 Ext: 1013
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
7/19/2023
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