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WALMART PHARMACY 10-5169
DSH180087 TAYLOR COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
TAYLOR COUNTY HOSPITAL DISTRICT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180087
Entity Address
1700 OLD LEBANON ROAD
CAMPBELLSVILLE, KY 42718
Medicare Provider Number
180087
Participating Start Date
10/1/2004
Last Recertification Date
8/19/2024
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
7/24/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
William Martin Snapp, CFO
(270) 465-3561
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
7/24/2023
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