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WALMART PHARMACY 10-5169
DSH330386 Garnet Health Medical Center - Catskills
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Covered Entity Details
Entity Name
Garnet Health Medical Center - Catskills
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330386
Entity Address
68 HARRIS BUSHVILLE ROAD
HARRIS, NY 12742-0000
Medicare Provider Number
330386
Participating Start Date
1/1/2007
Last Recertification Date
9/4/2024
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
7/2/2024
Contract Begin Date
10/1/2024
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
7/2/2024
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