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WAL-MART PHARMACY 10-5997
CAH041306-00 IZARD REGIONAL HOSPITAL, LLC
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Covered Entity Details
Entity Name
IZARD REGIONAL HOSPITAL, LLC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041306-00
Entity Address
61 GRASSE ST
CALICO ROCK, AR 72519
Medicare Provider Number
041306
Participating Start Date
4/1/2023
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony Thompson, Hospital Administrator
(870) 297-3726
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/12/2024
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