340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-0057

Pharmacy Address

1600 WEST MAIN STREET
WALNUT RIDGE, AR 72476

Pharmacy Comments

Approval Date

4/1/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Ernest L. Briner, COO
(870) 759-1193

Contract Pharmacy Representative

Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719

Signed By Date

4/1/2015