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WALMART PHARMACY 10-5169
CAH041321-00 BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA
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Covered Entity Details
Entity Name
BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041321-00
Entity Address
3050 TWIN RIVERS DRIVE
ARKADELPHIA, AR 71923-4299
Medicare Provider Number
041321
Participating Start Date
1/1/2011
Last Recertification Date
9/3/2024
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
4/16/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/16/2024
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