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WALMART PHARMACY 10-5169
CAH181323-00 Ohio County Hospital
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Covered Entity Details
Entity Name
Ohio County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181323-00
Entity Address
1211 Old Main Street
Hartford, KY 42347-1619
Medicare Provider Number
181323
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
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
10/6/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stuart Randall Hibbs, CFO
(270) 298-5288
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/6/2023
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