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WALMART PHARMACY 10-5169
CAH331318-00 Carthage Area Hospital, Inc.
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Covered Entity Details
Entity Name
Carthage Area Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331318-00
Entity Address
1001 West Street
Carthage, NY 13619
Medicare Provider Number
331318
Participating Start Date
1/1/2015
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
1/10/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rich Duvall, CEO
(315) 519-5201
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/10/2025
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