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WALMART PHARMACY 10-5169
SCH140089-00 MCDONOUGH DISTRICT HOSPITAL
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Covered Entity Details
Entity Name
MCDONOUGH DISTRICT HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140089-00
Entity Address
525 E. GRANT
MACOMB, IL 61455
Medicare Provider Number
140089
Participating Start Date
7/1/2017
Last Recertification Date
8/12/2024
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
William R Murdock, President & CEO
(309) 833-4101 Ext: 13499
Contract Pharmacy Representative
McDonough District Hospital
Jason Jarome Williamson, Pharmacy Director
(309) 833-4101 Ext: 13256
Signed By Date
4/15/2024
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