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WALMART PHARMACY 10-5169
RRC330126-00 Garnet Health Medical Center
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Covered Entity Details
Entity Name
Garnet Health Medical Center
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330126-00
Entity Address
707 E MAIN STREET
MIDDLETOWN, NY 10940-2650
Medicare Provider Number
330126
Participating Start Date
1/29/2021
Last Recertification Date
9/11/2024
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
James Grigg, CFO
(845) 333-2306
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2024
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