OrganizationWal-Mart Stores East Lp(Wal-Mart Pharmacy 10-2717)PharmacySuppliersPractice Address5901 U S Highway 49, Hattiesburg, MS 39402-2858(601) 296-9566PECOS 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 ID1073532057Provider TypeOrganizationFull NameWal-Mart Stores East LpOther NameWal-Mart Pharmacy 10-2717SubpartNoEnumeration Date7/19/2006Last Updated8/23/2023Contact InformationPractice LocationPractice Address5901 U S Highway 49, Hattiesburg, MS 39402-2858Phone(601) 296-9566FaxUnlisted FaxMailing LocationMailing Address702 SW 8th St, Bentonville, AR 72716-6209PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameLittle, Sarah (Director Of Healthcare Contracting)Phone(479) 277-2500Provider TaxonomiesCodeDescriptionLicenseCode3336C0003XPrimaryDescriptionPharmacySuppliersLicense04612MississippiCode332B00000XDescriptionDurable Medical Equipment & Medical SuppliesSuppliersLicenseUnlisted IssuerCode333600000XDescriptionPharmacySuppliersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID2045907DescriptionOtherIssuerPKID5759571DescriptionMedicaidIssuerUnlistedMississippiID05759571DescriptionMedicaidIssuerUnlistedMississippi