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WAL-MART PHARMACY WHSE #45
CAH451398-00 Prime Healthcare Services Pampa LLC d/b/a Pampa Regional Medical Center
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Covered Entity Details
Entity Name
Prime Healthcare Services Pampa LLC d/b/a Pampa Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451398-00
Entity Address
1 Medical Plaza
Pampa, TX 79065
Medicare Provider Number
451398
Participating Start Date
10/1/2023
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY WHSE #45
Pharmacy Address
2250 NORTH 8TH STREET
SUITE 102-A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/9/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Gill, CEO
(405) 887-0411
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/9/2024
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