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WAL-MART PHARMACY 10-0034
SCH260034-00 BATES COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BATES COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260034-00
Entity Address
615 WEST NURSERY STREET
BUTLER, MO 64730-0370
Medicare Provider Number
260034
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0034
Pharmacy Address
2250 LINCOLN AVE
NEVADA, MO 64772
Pharmacy Comments
Contract Details
Approval Date
4/17/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Greg Weaver, CEO
(660) 200-7105
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/2/2025
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