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 yesterday at 11:47 AM.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