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WALMART PHARMACY 10-5169
DSH450597 DEWITT MEDICAL DISTRICT DBA CUERO REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
DEWITT MEDICAL DISTRICT DBA CUERO REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450597
Entity Address
2550 N ESPLANADE ST
CUERO, TX 77954-4736
Medicare Provider Number
450597
Participating Start Date
1/1/2005
Last Recertification Date
8/20/2024
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
1/5/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alma Alexander, CFO
(361) 275-6191
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/5/2024
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