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WALMART PHARMACY 10-5169
CAH451362-00 CLAY COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CLAY COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451362-00
Entity Address
310 WEST SOUTH STREET
HENRIETTA, TX 76365
Medicare Provider Number
451362
Participating Start Date
1/1/2016
Last Recertification Date
8/26/2024
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
1/10/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DEBRA HAEHN, CFO
(940) 235-1202
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/10/2024
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