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WAL-MART PHARMACY 10-1196
CH0610680 INNIS COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
INNIS COMMUNITY HEALTH CENTER, INC.
Subdivision Name
INNIS COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0610680
Entity Address
6450 LA HIGHWAY 1 STE B
INNIS, LA 70747-0889
Grant Number
H80CS00855
Participating Start Date
1/1/2004
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1196
Pharmacy Address
460 HOSPITAL ROAD
NEW ROADS, LA 70760
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
cindy peavy, Executive Director
(225) 235-9627
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/15/2020
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