OrganizationWal-Mart Stores East Lp(Wal-Mart Pharmacy 10-3234)PharmacySuppliersPractice Address4331 Highway 66 S, Rogersville, TN 37857-3145(423) 272-9393(479) 204-8550PECOS 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 4 days ago.Profile DetailsProvider ID1619994811Provider TypeOrganizationFull NameWal-Mart Stores East LpOther NameWal-Mart Pharmacy 10-3234SubpartNoEnumeration Date7/16/2006Last Updated8/30/2023Contact InformationPractice LocationPractice Address4331 Highway 66 S, Rogersville, TN 37857-3145Phone(423) 272-9393Fax(423) 272-3247Mailing LocationMailing Address702 SW 8th St, Bentonville, AR 72716-0445Phone(479) 204-8550Fax(479) 277-4331Authorized OfficialNameLittle, Sarah (Director Of Healthcare Contracting)Phone(479) 277-2500Provider TaxonomiesCodeDescriptionLicenseCode3336C0003XPrimaryDescriptionPharmacySuppliersLicense3764TennesseeCode332B00000XDescriptionDurable Medical Equipment & Medical SuppliesSuppliersLicenseUnlisted IssuerCode333600000XDescriptionPharmacySuppliersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID2093238DescriptionOtherIssuerPKID1454253DescriptionMedicaidIssuerUnlistedTennessee