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WAL-MART PHARMACY 10-3331
DSH040016 UNIVERSITY OF ARKANSAS HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF ARKANSAS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040016
Entity Address
4301 WEST MARKHAM ST
Slot 571
LITTLE ROCK, AR 72205
Medicare Provider Number
040016
Participating Start Date
12/1/1992
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3331
Pharmacy Address
5501 SOUTH OLIVE ST
PINE BLUFF, AR 71603
Pharmacy Comments
Contract Details
Approval Date
9/7/2012
Contract Begin Date
9/7/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MELISSA FONTAINE, Chief Operating Officer
(501) 686-8955
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
8/21/2012
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