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WAL-MART PHARMACY 10-0055
CAH041318-00 Mercy Hospital Booneville
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Covered Entity Details
Entity Name
Mercy Hospital Booneville
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041318-00
Entity Address
880 W Main
Booneville, AR 72927
Medicare Provider Number
041318
Participating Start Date
1/1/2013
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0055
Pharmacy Address
1400 EAST MAIN STREET
BOONEVILLE, AR 72927
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
Sherry Clouse Day, VP Finance - Mercy CAH
(417) 820-8439
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting
(479) 277-3719
Signed By Date
7/15/2024
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