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WAL-MART PHARMACY 10-0785
CAH251316-00 H.C. WATKINS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
H.C. WATKINS MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251316-00
Entity Address
605 S ARCHUSA AVE
QUITMAN, MS 39355-2331
Medicare Provider Number
251316
Participating Start Date
4/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0785
Pharmacy Address
1350 AZALEA DR
WAYNESBORO, MS 39367
Pharmacy Comments
Contract Details
Approval Date
7/3/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/16/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CLINTON EAVES, ADMINISTRATOR
(601) 776-6925 Ext: 2180
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/3/2013
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