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WAL-MART PHARMACY 10-1128
DSH190019 CHRISTUS ST FRANCES CABRINI HOSPITAL
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Covered Entity Details
Entity Name
CHRISTUS ST FRANCES CABRINI HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190019
Entity Address
3330 MASONIC DRIVE
ALEXANDRIA, LA 71301
Medicare Provider Number
190019
Participating Start Date
4/1/2006
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1128
Pharmacy Address
7162 HWY 1
MARKSVILLE, LA 71351
Pharmacy Comments
Contract Details
Approval Date
1/23/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/19/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nancy Hellyer, CEO
(318) 561-7173
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/23/2016
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