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WALMART PHARMACY 10-5169
CAH161364-00 JEFFERSON COUNTY HEALTH CENTER
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Covered Entity Details
Entity Name
JEFFERSON COUNTY HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161364-00
Entity Address
2000 SOUTH MAIN STREET
FAIRFIELD, IA 52556
Medicare Provider Number
161364
Participating Start Date
8/24/2010
Last Recertification Date
8/16/2024
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
1/2/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRYAN HUNGER, CEO
(641) 469-4303
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/2/2024
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