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WAL-MART PHARMACY 10-0036
DSH040039 ARKANSAS METHODIST MEDICAL CENTER
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Covered Entity Details
Entity Name
ARKANSAS METHODIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040039
Entity Address
900 WEST KINGS HIGHWAY
PARAGOULD, AR 72450
Medicare Provider Number
040039
Participating Start Date
1/1/2024
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0036
Pharmacy Address
2802 WEST KINGS HIGHWAY
PARAGOULD, AR 72450
Pharmacy Comments
Contract Details
Approval Date
10/24/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Staci J Williams, CFO
(870) 239-7105
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/12/2023
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