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WAL-MART PHARMACY 10-1078
CAH451310-00 BALLINGER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BALLINGER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451310-00
Entity Address
608 AVENUE B
BALLINGER, TX 76821
Medicare Provider Number
451310
Participating Start Date
9/29/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1078
Pharmacy Address
2005 HUTCHINS AVE
BALLINGER, TX 76821
Pharmacy Comments
Contract Details
Approval Date
4/13/2012
Contract Begin Date
4/13/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lance Keilers, CEO
(325) 365-2531
Contract Pharmacy Representative
Wal--Mart
Marcus Osborne, Sales & Contracting
(479) 204-8452
Signed By Date
4/6/2012
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