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WAL-MART PHARMACY 10-5997
CH062480 CATAHOULA PARISH HOSPITAL DISTRICT # 2
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Covered Entity Details
Entity Name
CATAHOULA PARISH HOSPITAL DISTRICT # 2
Subdivision Name
ISLAND MEDICAL & DENTAL
Type
HRSA-Funded Health Center
340B ID
CH062480
Entity Address
307 Chisum St
Sicily Island, LA 71368
Grant Number
H80CS00206
Participating Start Date
1/1/1999
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
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
Debra K. Miesch, CEO
(318) 389-5727 Ext: 1407
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/15/2020
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