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WAL-MART PHARMACY 10-0489
DSH190015 North Oaks Medical Center LLC
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Covered Entity Details
Entity Name
North Oaks Medical Center LLC
Subdivision Name
DBA NORTH OAKS MEDICAL CENTER LLC
Type
Disproportionate Share Hospital
340B ID
DSH190015
Entity Address
15790 PAUL VEGA M.D. DRIVE
HAMMOND, LA 70403
Medicare Provider Number
190015
Participating Start Date
4/1/2005
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0489
Pharmacy Address
2799 W THOMAS STREET
HAMMOND, LA 70401
Pharmacy Comments
Contract Details
Approval Date
7/1/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark T Anderson, CFO
(985) 230-6602
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/1/2019
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