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WALMART PHARMACY 10-2940
DSH190011 BRFHH Monroe LLC d/b/a Ochsner LSU Health Monroe
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Covered Entity Details
Entity Name
BRFHH Monroe LLC d/b/a Ochsner LSU Health Monroe
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190011
Entity Address
4864 JACKSON STREET
MONROE, LA 71202
Medicare Provider Number
190011
Participating Start Date
1/1/1998
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-2940
Pharmacy Address
5251 CYPRESS STREET
WEST MONROE, LA 71291
Pharmacy Comments
Contract Details
Approval Date
1/18/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark A Randolph, CEO
(318) 584-2569
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/18/2021
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