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Walmart Pharmacy 10-7611
CAH031317-00 La Paz Regional Hospital
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Covered Entity Details
Entity Name
La Paz Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031317-00
Entity Address
1200 W Mohave Road
Parker, AZ 85344
Medicare Provider Number
031317
Participating Start Date
4/1/2014
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Zafer L. Genc, Director of Pharmacy
(928) 669-7452
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/16/2023
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