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WAL-MART PHARMACY 10-0016
DSH040051 Baptist Health Medical Center - Drew County
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Covered Entity Details
Entity Name
Baptist Health Medical Center - Drew County
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040051
Entity Address
778 SCOGIN DRIVE
MONTICELLO, AR 71655
Medicare Provider Number
040051
Participating Start Date
7/1/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0016
Pharmacy Address
2214 FAYETTEVILLE ROAD
VAN BUREN, AR 72956
Pharmacy Comments
Contract Details
Approval Date
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/17/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Scott Barrilleaux, CEO
(870) 460-3589
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/15/2016
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