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WAL-MART PHARMACY 10-0874
CAH251309-00 FIELD MEMORIAL COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
FIELD MEMORIAL COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251309-00
Entity Address
178 HWY 24
CENTREVILLE, MS 39631-4171
Medicare Provider Number
251309
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0874
Pharmacy Address
314 SGT. S. PRENTISS DR
NATCHEZ, MS 39120
Pharmacy Comments
Contract Details
Approval Date
1/21/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CHAD NETTERVILLE, CEO
(601) 890-0545
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/21/2016
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