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WAL-MART PHARMACY 10-1109
CAH191323-01 Hospital Service District 1A, Parish of Richland, State of Louisiana, DBA Richland Parish Hospital
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Covered Entity Details
Entity Name
Hospital Service District 1A, Parish of Richland, State of Louisiana, DBA Richland Parish Hospital
Subdivision Name
Delhi Rural Health Clinic
Type
Critical Access Hospital
340B ID
CAH191323-01
Entity Address
508 Broadway Street
Delhi, LA 71232
Medicare Provider Number
191323
Outpatient Facility Provider Number
193417
Participating Start Date
7/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1109
Pharmacy Address
1806 S JULIA ST
RAYVILLE, LA 71269
Pharmacy Comments
Contract Details
Approval Date
7/10/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Carroll, CEO
(318) 878-6323
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/10/2018
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