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WALMART PHARMACY 10-5169
CAH671301-00 Hemphill County Hospital
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Covered Entity Details
Entity Name
Hemphill County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH671301-00
Entity Address
1020 S 4th St.
Canadian, TX 79014
Medicare Provider Number
671301
Participating Start Date
4/1/2024
Last Recertification Date
8/19/2024
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
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelsey Haley, CEO
(806) 323-1126
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2024
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