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Walmart Pharmacy 10-7611
DSH040072 BAPTIST HEALTH MEDICAL CENTER - STUTTGART
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Covered Entity Details
Entity Name
BAPTIST HEALTH MEDICAL CENTER - STUTTGART
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040072
Entity Address
1703 NORTH BUERKLE
STUTTGART, AR 72160
Medicare Provider Number
040072
Participating Start Date
1/1/2011
Last Recertification Date
9/18/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/16/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
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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