OrganizationWal-Mart Stores East Lp(Walmart Pharmacy 10-0916)PharmacySuppliersPractice Address6072 U S Highway 98, Hattiesburg, MS 39402-8854(601) 264-3631PECOS EnrollmentBased on the most recent information from CMS, provider Wal-Mart Stores East Lp does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1063439461Provider TypeOrganizationFull NameWal-Mart Stores East LpOther NameWalmart Pharmacy 10-0916SubpartNoEnumeration Date7/16/2006Last Updated8/24/2023Contact InformationPractice LocationPractice Address6072 U S Highway 98, Hattiesburg, MS 39402-8854Phone(601) 264-3631FaxUnlisted FaxMailing LocationMailing Address702 SW 8th St, Bentonville, AR 72716-0445PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameLittle, Sarah (Director Of Healthcare Contracting)Phone(479) 277-2500Provider TaxonomiesCodeDescriptionLicenseCode3336C0003XPrimaryDescriptionPharmacySuppliersLicense01938MississippiCode332B00000XDescriptionDurable Medical Equipment & Medical SuppliesSuppliersLicenseUnlisted IssuerCode333600000XDescriptionPharmacySuppliersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID580884DescriptionMedicaidIssuerUnlistedMississippiID2044966DescriptionOtherIssuerPKID00580884DescriptionMedicaidIssuerUnlistedMississippi