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WALMART PHARMACY 10-5169
CH045207AC CUMBERLAND FAMILY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
CUMBERLAND FAMILY MEDICAL CENTER, INC.
Subdivision Name
Casey County High Healthy Kids Clinic
Type
HRSA-Funded Health Center
340B ID
CH045207AC
Entity Address
1841 E. KY 70
Liberty, KY 42539-6718
Grant Number
H80CS08218
Participating Start Date
1/1/2016
Last Recertification Date
2/20/2025
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
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ryan Smith, CFO
(270) 858-6655
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/5/2023
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