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WALMART PHARMACY 10-5169
CAH171380-00 NEOSHO MEMORIAL REGIONAL MED CTR
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Covered Entity Details
Entity Name
NEOSHO MEMORIAL REGIONAL MED CTR
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171380-00
Entity Address
629 SOUTH PLUMMER AVENUE
CHANUTE, KS 66720
Medicare Provider Number
171380
Participating Start Date
1/1/2019
Last Recertification Date
8/21/2024
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
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wendy Brazil, COO
(620) 432-5310
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/16/2024
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