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Walmart Pharmacy 10-7611
CAH041302-00 DARDANELLE HOSPITAL
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Covered Entity Details
Entity Name
DARDANELLE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041302-00
Entity Address
200 NORTH THIRD
DARDANELLE, AR 72834
Medicare Provider Number
041302
Participating Start Date
4/28/2021
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
10/14/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Reed, VP of Clinical Support Services/CIO
(501) 513-5152
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/14/2023
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