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WAL-MART PHARMACY 10-1069
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 10-1069
Pharmacy Address
231 EASTSIDE DRIVE
NEWTON, MS 39345
Pharmacy Comments
Contract Details
Approval Date
4/13/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Nester, ADMINISTRATOR
(601) 776-6925 Ext: 2180
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/13/2017
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