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Walmart Pharmacy 10-7611
SCH110071-00 Appling General Hospital
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Covered Entity Details
Entity Name
Appling General Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH110071-00
Entity Address
163 E Tollison Street
Baxley, GA 31513
Medicare Provider Number
110071
Participating Start Date
1/1/2014
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
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
Andrea Pierce, CEO
(912) 367-9841 Ext: 1230
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/12/2023
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