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Walmart Pharmacy 10-7611
CAH451377-00 REEVES COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
REEVES COUNTY HOSPITAL DISTRICT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451377-00
Entity Address
2349 MEDICAL DRIVE
PECOS, TX 79772-7338
Medicare Provider Number
451377
Participating Start Date
9/24/2010
Last Recertification Date
8/19/2024
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
BOMI BHARUCHA, CHIEF FINANCIAL OFFICER
(432) 447-3551 Ext: 1118
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/12/2023
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