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 yesterday at 11:47 AM.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