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WALMART PHARMACY 10-5169
SCH140001-00 GRAHAM HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
GRAHAM HOSPITAL ASSOCIATION
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140001-00
Entity Address
210 W. Walnut Street
Canton, IL 61520
Medicare Provider Number
140001
Participating Start Date
7/1/2015
Last Recertification Date
8/26/2024
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
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Holly Henline, VP of Ancillary Services & Corporate Compliance Officer
(309) 647-5240 Ext: 2709
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/13/2023
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