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WALMART PHARMACY 10-5169
DSH370034 MCALESTER REGIONAL HEALTH CENTER
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Covered Entity Details
Entity Name
MCALESTER REGIONAL HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370034
Entity Address
1 CLARK BASS BOULEVARD
MCALESTER, OK 74501
Medicare Provider Number
370034
Participating Start Date
7/1/2024
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/17/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cheryl Perry, Chief Financial Officer
(918) 421-8626
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/15/2024
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