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WAL-MART PHARMACY 10-0071
CAH041309-00 LAWRENCE MEMORIAL HEALTH FOUNDATION, INC
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Covered Entity Details
Entity Name
LAWRENCE MEMORIAL HEALTH FOUNDATION, INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041309-00
Entity Address
1309 W MAIN ST
WALNUT RIDGE, AR 72476-1430
Medicare Provider Number
041309
Participating Start Date
4/1/2015
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0071
Pharmacy Address
1415 HWY 67 SOUTH
POCAHONTAS, AR 72455
Pharmacy Comments
Contract Details
Approval Date
7/10/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joshua T. Conlee, President
(870) 886-1266
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/10/2024
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