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WALMART PHARMACY 10-5169
SCH470024-00 Northwestern Medical Center, Inc.
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Covered Entity Details
Entity Name
Northwestern Medical Center, Inc.
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH470024-00
Entity Address
133 Fairfield Street
St. Albans, VT 05478
Medicare Provider Number
470024
Participating Start Date
1/1/2012
Last Recertification Date
8/15/2024
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
Stephanie Alicia Breault, CFO
(802) 524-8823
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/12/2023
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