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WAL-MART PHARMACY 10-5022
DSH190046 TOURO INFIRMARY
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Covered Entity Details
Entity Name
TOURO INFIRMARY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190046
Entity Address
1401 FOUCHER STREET
NEW ORLEANS, LA 70115
Medicare Provider Number
190046
Participating Start Date
4/1/2006
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5022
Pharmacy Address
1901 TCHOPITOULAS STREET
NEW ORLEANS, LA 70130
Pharmacy Comments
Contract Details
Approval Date
2/26/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/16/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James T. Montgomery, President/CEO
(504) 897-8246
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/9/2013
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