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WALMART PHARMACY 10-5169
CAH331317-00 LEWIS COUNTY GENERAL HOSPITAL
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Covered Entity Details
Entity Name
LEWIS COUNTY GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331317-00
Entity Address
7785 NORTH STATE STREET
LOWVILLE, NY 13367
Medicare Provider Number
331317
Participating Start Date
10/1/2014
Last Recertification Date
8/30/2024
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
10/2/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gerald R Cayer, CEO
(315) 376-5203
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/2/2023
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