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WALMART PHARMACY 10-5169
DSH330276 NATHAN LITTAUER HOSPITAL
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Covered Entity Details
Entity Name
NATHAN LITTAUER HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330276
Entity Address
99 EAST STATE STREET
GLOVERSVILLE, NY 12078
Medicare Provider Number
330276
Participating Start Date
10/1/2010
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
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Ostrander, Vice President-Finance & CFO
(518) 773-5480
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/12/2023
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