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WAL-MART PHARMACY 10-0190
CAH041330-00 Piggott Community Hospital
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Covered Entity Details
Entity Name
Piggott Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041330-00
Entity Address
1206 Gordon Duckworth Drive
Piggott, AR 72454-1911
Medicare Provider Number
041330
Participating Start Date
4/1/2014
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0190
Pharmacy Address
1500 E FIRST ST
KENNETT, MO 63857
Pharmacy Comments
Contract Details
Approval Date
1/19/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Magee, Executive Director
(870) 598-3881
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/19/2015
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