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WALMART PHARMACY 10-5169
CAH331323-00 Wyoming County Community Hospital
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Covered Entity Details
Entity Name
Wyoming County Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331323-00
Entity Address
400 N Main St
Warsaw, NY 14569
Medicare Provider Number
331323
Participating Start Date
1/1/2025
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
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Wright, Chief Financial Officer
(585) 786-8940
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/8/2024
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