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WALMART PHARMACY 10-5169
CAH511308-00 BRAXTON COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BRAXTON COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511308-00
Entity Address
100 HOYLMAN DRIVE
GASSAWAY, WV 26624-9320
Medicare Provider Number
511308
Participating Start Date
9/21/2010
Last Recertification Date
8/15/2024
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
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robin Eckhart, VP-Finance
(304) 872-8408
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/4/2023
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