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WAL-MART PHARMACY 10-1109
DSH190151 RICHARDSON MEDICAL CENTER
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Covered Entity Details
Entity Name
RICHARDSON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190151
Entity Address
254 HWY 3048
RAYVILLE, LA 71269
Medicare Provider Number
190151
Participating Start Date
7/1/2005
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1109
Pharmacy Address
1806 S JULIA ST
RAYVILLE, LA 71269
Pharmacy Comments
Contract Details
Approval Date
10/5/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Barrett, CEO
(318) 728-8389
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/5/2018
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