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Walmart Pharmacy 10-7611
SCH250036-00 GEORGE COUNTY HOSPITAL
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Covered Entity Details
Entity Name
GEORGE COUNTY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH250036-00
Entity Address
859 WINTER STREET
LUCEDALE, MS 39452-6603
Medicare Provider Number
250036
Participating Start Date
4/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GREG HAVARD, CHIEF EXECUTIVE OFFICER
(601) 947-9148
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/5/2023
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