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WALMART PHARMACY 10-5169
CAH371320-00 CLEVELAND AREA HOSPITAL
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Covered Entity Details
Entity Name
CLEVELAND AREA HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371320-00
Entity Address
1401 W PAWNEE
CLEVELAND, OK 74020
Medicare Provider Number
371320
Participating Start Date
1/1/2022
Last Recertification Date
8/23/2024
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
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Melva D. Bostik, RN, BSN, RHCNOC
(918) 358-2501 Ext: 4326
Contract Pharmacy Representative
Walmart
Nick Tallman, Senior Director of Mechandising
(479) 371-0431
Signed By Date
4/14/2025
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