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WAL-MART PHARMACY 10-0296
DSH040029 CONWAY REGIONAL MEDICAL CENTER INC
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Covered Entity Details
Entity Name
CONWAY REGIONAL MEDICAL CENTER INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040029
Entity Address
2302 COLLEGE AVENUE
CONWAY, AR 72034
Medicare Provider Number
040029
Participating Start Date
10/1/2017
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0296
Pharmacy Address
1172 NO. HWY 7
DARDANELLE, AR 72834
Pharmacy Comments
Contract Details
Approval Date
4/2/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Reed, VP of Clinical Support Services/CIO
(501) 513-5152
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/2/2025
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