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WALMART PHARMACY 10-5169
CAH171350-00 Russell Regional Hospital
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Covered Entity Details
Entity Name
Russell Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171350-00
Entity Address
200 S. Main Street
Russell, KS 67665
Medicare Provider Number
171350
Participating Start Date
7/1/2014
Last Recertification Date
8/12/2024
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
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Paul Caudill, CEO
(785) 483-0708
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/9/2023
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