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WALMART PHARMACY 10-5169
RRC140135-00 Decatur Memorial Hospital
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Covered Entity Details
Entity Name
Decatur Memorial Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140135-00
Entity Address
2300 N. Edward St.
Decatur, IL 62526
Medicare Provider Number
140135
Participating Start Date
7/1/2013
Last Recertification Date
8/22/2024
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
1/4/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Drew Early, President CEO
(217) 876-2114
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/4/2024
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