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WAL-MART PHARMACY 10-0016
DSH040062 MERCY HOSPITAL FORT SMITH
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Covered Entity Details
Entity Name
MERCY HOSPITAL FORT SMITH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040062
Entity Address
7301 ROGERS AVENUE
FORT SMITH, AR 72903
Medicare Provider Number
040062
Participating Start Date
4/1/2015
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0016
Pharmacy Address
2214 FAYETTEVILLE ROAD
VAN BUREN, AR 72956
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Greta Wilcher, Vice-President Finance
(479) 314-6100 Ext: 6104
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting
(479) 277-3719
Signed By Date
7/15/2024
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