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WAL-MART PHARMACY 10-0118
CAH251302-00 BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251302-00
Entity Address
400 SOUTH CHESTNUT ST
ABERDEEN, MS 39730
Medicare Provider Number
251302
Participating Start Date
9/24/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0118
Pharmacy Address
1515 U.S. HWY 278 EAST
AMORY, MS 38821
Pharmacy Comments
Contract Details
Approval Date
4/16/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph S. McNulty III, President
(601) 849-6440
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/16/2014
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