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WALMART PHARMACY 10-5169
CAH041329-00 MERCY HOSPITAL BERRYVILLE
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Covered Entity Details
Entity Name
MERCY HOSPITAL BERRYVILLE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041329-00
Entity Address
214 CARTER STREET
BERRYVILLE, AR 72616
Medicare Provider Number
041329
Participating Start Date
1/1/2011
Last Recertification Date
8/22/2024
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
7/15/2024
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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