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WAL-MART PHARMACY 10-0309
DSH190034 ABBEVILLE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
ABBEVILLE GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190034
Entity Address
118 NORTH HOSPITAL DRIVE
ABBEVILLE, LA 70510
Medicare Provider Number
190034
Participating Start Date
9/15/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0309
Pharmacy Address
3005 VETERANS MEMORIAL DRIVE
ABBEVILLE, LA 70510-4140
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ray Landry, CEO
(337) 898-6500
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/15/2019
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