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WAL-MART PHARMACY 10-0066
CAH041303-00 MERCY HOSPITAL OZARK
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Covered Entity Details
Entity Name
MERCY HOSPITAL OZARK
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041303-00
Entity Address
801 WEST RIVER
OZARK, AR 72949
Medicare Provider Number
041303
Participating Start Date
7/1/2024
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0066
Pharmacy Address
230 MARKET ST
CLARKSVILLE, AR 72830-9069
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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