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WALMART PHARMACY 10-5169
DSH340107 East Carolina Health-Heritage, Inc. d/b/a ECU Health Edgecombe Hospital
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Covered Entity Details
Entity Name
East Carolina Health-Heritage, Inc. d/b/a ECU Health Edgecombe Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340107
Entity Address
111 HOSPITAL DRIVE
TARBORO, NC 27886
Medicare Provider Number
340107
Participating Start Date
7/1/2003
Last Recertification Date
9/5/2024
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
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles Alford, Vice President, Financial Services
(252) 641-7131
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/12/2024
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