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WAL-MART PHARMACY 10-5315
CAH191315-02 HARDTNER MEDICAL CENTER
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Covered Entity Details
Entity Name
HARDTNER MEDICAL CENTER
Subdivision Name
LASALLE PARISH HOSPITAL SERVICE DIS / HARDTNER FAMILY CLINIC
Type
Critical Access Hospital
340B ID
CAH191315-02
Entity Address
1102 NORTH PINE RD
HARDTNER MEDICAL CENTER
OLLA, LA 71465-4804
Medicare Provider Number
191315
Outpatient Facility Provider Number
193493
Participating Start Date
10/1/2016
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul G. Mathews, Administrator
(318) 495-3131 Ext: 109
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/15/2021
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