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WAL-MART PHARMACY 10-1114
CAH041310-00 White River Health System, Inc. DBA Stone County Medical Center
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Covered Entity Details
Entity Name
White River Health System, Inc. DBA Stone County Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041310-00
Entity Address
2106 East Main Street
Mountain View, AR 72560
Medicare Provider Number
041310
Participating Start Date
10/1/2011
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1114
Pharmacy Address
409 SYLAMORE AVENUE
MOUNTAIN VIEW, AR 72560
Pharmacy Comments
Contract Details
Approval Date
4/3/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jana Richardson, Controller
(870) 262-3222
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/3/2014
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