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WALMART PHARMACY 10-5169
DSH040016 UNIVERSITY OF ARKANSAS HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF ARKANSAS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040016
Entity Address
4301 WEST MARKHAM ST
Slot 571
LITTLE ROCK, AR 72205
Medicare Provider Number
040016
Participating Start Date
12/1/1992
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
9/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey J Cook, Chief Pharmacy Officer
(501) 686-6690
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
9/14/2023
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