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WAL-MART PHARMACY 10-5315
SCH040067-00 MAGNOLIA REGIONAL HEALTH SYSTEM INC
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Covered Entity Details
Entity Name
MAGNOLIA REGIONAL HEALTH SYSTEM INC
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH040067-00
Entity Address
101 Hospital Drive
MAGNOLIA, AR 71753
Medicare Provider Number
040067
Participating Start Date
7/1/2024
Last Recertification Date
9/9/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
4/23/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brett Kinman, CEO
(870) 235-3212
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
4/12/2024
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