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WAL-MART PHARMACY 10-0107
RRC440002-00 Jackson-Madison County General Hospital District dba Jackson-Madison County General Hospital
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Covered Entity Details
Entity Name
Jackson-Madison County General Hospital District dba Jackson-Madison County General Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC440002-00
Entity Address
620 Skyline Drive
Jackson, TN 38301
Medicare Provider Number
440002
Participating Start Date
4/1/2018
Last Recertification Date
9/7/2018
Entity Termination Date
3/31/2019
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0107
Pharmacy Address
134 COURT RIGHT ROAD
MARTIN, TN 38237
Pharmacy Comments
Contract Details
Approval Date
7/10/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/12/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BOBBY ARNOLD, CEO
(731) 541-6730
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/10/2014
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