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WALMART PHARMACY 10-5169
CAH671300-00 Graham Regional Medical Center
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Covered Entity Details
Entity Name
Graham Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH671300-00
Entity Address
1301 Montgomery Road
Graham, TX 76450
Medicare Provider Number
671300
Participating Start Date
4/1/2024
Last Recertification Date
8/14/2024
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
1/31/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Shane Kernell, CEO
(940) 521-5302
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/12/2024
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