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WALMART PHARMACY 10-5169
CAH141341-00 PANA COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
PANA COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141341-00
Entity Address
101 E. 9TH STREET
PANA, IL 62557-1716
Medicare Provider Number
141341
Participating Start Date
7/1/2017
Last Recertification Date
8/14/2024
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
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Trina Casner, President & CEO
(217) 562-6313
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/15/2025
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