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WALMART PHARMACY 10-5169
CAH281326-00 Antelope Memorial Hospital
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Covered Entity Details
Entity Name
Antelope Memorial Hospital
Subdivision Name
Antelope Memorial Hospital
Type
Critical Access Hospital
340B ID
CAH281326-00
Entity Address
102 West 9th Street
Neligh, NE 68756-1114
Medicare Provider Number
281326
Participating Start Date
10/1/2012
Last Recertification Date
8/20/2024
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
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Martha Nelson, CFO
(402) 887-6282 Ext: 6282
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/11/2024
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