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WAL-MART PHARMACY 10-5315
CAH191305-00 ST. JAMES PARISH HOSPITAL
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Covered Entity Details
Entity Name
ST. JAMES PARISH HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191305-00
Entity Address
1645 LUTCHER AVENUE
LUTCHER, LA 70071
Medicare Provider Number
191305
Participating Start Date
9/9/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
1/7/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MARY ELLEN PRATT, CEO
(225) 746-2990
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/7/2020
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