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WAL-MART PHARMACY 10-0601
CAH451324-00 LILLIAN M. HUDSPETH MEMORIAL HOSP.
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Covered Entity Details
Entity Name
LILLIAN M. HUDSPETH MEMORIAL HOSP.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451324-00
Entity Address
308 HUDSPETH AVE.
SONORA, TX 76950
Medicare Provider Number
451324
Participating Start Date
7/1/2019
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0601
Pharmacy Address
5501 SHERWOOD WAY
SAN ANGELO, TX 76904
Pharmacy Comments
Contract Details
Approval Date
1/16/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Lance Keilers, CEO
(325) 387-1200
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/16/2017
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