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WALMART PHARMACY 10-5169
DSH040036 BAPTIST HEALTH MEDICAL CENTER- NLR
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Covered Entity Details
Entity Name
BAPTIST HEALTH MEDICAL CENTER- NLR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040036
Entity Address
3333 SPRINGHILL DRIVE
NORTH LITTLE ROCK, AR 72117
Medicare Provider Number
040036
Participating Start Date
10/1/2024
Last Recertification Date
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
7/18/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/12/2024
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