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WAL-MART PHARMACY 10-1107
CH063380 SWLA CENTER FOR HEALTH SERVICES
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Covered Entity Details
Entity Name
SWLA CENTER FOR HEALTH SERVICES
Subdivision Name
SOUTHWEST LOUISIANA CENTER FOR HEALTH SERVICES
Type
HRSA-Funded Health Center
340B ID
CH063380
Entity Address
2000 Opelousas St
Lake Charles, LA 70601-2641
Grant Number
H80CS00558
Participating Start Date
10/1/2002
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1107
Pharmacy Address
1900 HWY 165 SOUTH
OAKDALE, LA 71463
Pharmacy Comments
Contract Details
Approval Date
4/25/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tommie Anderson, CEO
(337) 493-5115
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/25/2017
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