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WAL-MART PHARMACY 10-5315
CAH191301-00 UNION GENERAL HOSPITAL
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Covered Entity Details
Entity Name
UNION GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191301-00
Entity Address
901 JAMES AVE
FARMERVILLE, LA 71241
Medicare Provider Number
191301
Participating Start Date
4/1/2014
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
EVALYN ORMOND, CEO
(318) 368-7090
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/14/2020
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