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WAL-MART PHARMACY 10-0119
DSH040014 WHITE COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
WHITE COUNTY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040014
Entity Address
3214 East Race Avenue
SEARCY, AR 72143
Medicare Provider Number
040014
Participating Start Date
4/1/2015
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0119
Pharmacy Address
3150 HARRISON ST
BATESVILLE, AR 72501
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
STUART HILL, VP/CFO
(501) 380-1004
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/15/2016
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