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Walmart Pharmacy 10-7611
SCH250095-00 South Sunflower County Hospital
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Covered Entity Details
Entity Name
South Sunflower County Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH250095-00
Entity Address
121 East Baker Street
Indianola, MS 38751-2462
Medicare Provider Number
250095
Participating Start Date
10/1/2013
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
Courtney Phillips, Administrator/CFO
(662) 635-7200
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/12/2023
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