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WAL-MART PHARMACY 10-1078
CAH451315-01 NORTH RUNNELS HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
NORTH RUNNELS HOSPITAL DISTRICT
Subdivision Name
North Runnels Clinic
Type
Critical Access Hospital
340B ID
CAH451315-01
Entity Address
7571 State Hwy 153
Winters, TX 79567
Medicare Provider Number
451315
Outpatient Facility Provider Number
458865
Participating Start Date
7/1/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1078
Pharmacy Address
2005 HUTCHINS AVE
BALLINGER, TX 76821
Pharmacy Comments
Contract Details
Approval Date
6/4/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Mathis, CEO/Administrator
(325) 754-1317
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/16/2018
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