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WALMART PHARMACY 10-5169
RRC040010-00 MERCY MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC040010-00
Entity Address
2710 S. RIFE MEDICAL LANE
ROGERS, AR 72758
Medicare Provider Number
040010
Participating Start Date
10/1/2024
Last Recertification Date
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
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Greta Wilcher, Vice-President Finance
(479) 314-6100 Ext: 6104
Contract Pharmacy Representative
Walmart
Christian Nava, Senior Manager, Program Development-340B
(210) 632-0647
Signed By Date
4/14/2025
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