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WAL-MART PHARMACY 10-0533
DSH190006 UNIVERSITY HOSPITAL AND CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL AND CLINICS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190006
Entity Address
2390 W CONGRESS ST.
LAFAYETTE, LA 70506
Medicare Provider Number
190006
Participating Start Date
1/1/1998
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0533
Pharmacy Address
1205 E ADMIRAL DOYLE
NEW IBERIA, LA 70560
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Katherine Hebert, Chief Executive Officer
(337) 261-6004
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2021
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