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WAL-MART PHARMACY 10-0016
RRC040004-00 WASHINGTON REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
WASHINGTON REGIONAL MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC040004-00
Entity Address
3215 N. NORTH HILLS BLVD
FAYETTEVILLE, AR 72703
Medicare Provider Number
040004
Participating Start Date
4/1/2022
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0016
Pharmacy Address
2214 FAYETTEVILLE ROAD
VAN BUREN, AR 72956
Pharmacy Comments
Contract Details
Approval Date
4/5/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dennis Charles Burrows, Vice President & Chief Accounting Officer
(479) 463-1120
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/5/2024
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