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WALMART PHARMACY 10-5169
CAH451337-00 Lockney General Hospital District
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Covered Entity Details
Entity Name
Lockney General Hospital District
Subdivision Name
dba W.J. Mangold Memorial Hospital
Type
Critical Access Hospital
340B ID
CAH451337-00
Entity Address
320 N. Main
Lockney, TX 79241
Medicare Provider Number
451337
Participating Start Date
1/1/2013
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
Vincent DiFranco, CEO
(806) 652-3373 Ext: 204
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/4/2023
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