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WAL-MART PHARMACY 10-0428
CAH191306-02 WEST FELICIANA PARISH HOSPITAL
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Covered Entity Details
Entity Name
WEST FELICIANA PARISH HOSPITAL
Subdivision Name
West Feliciana Hospital Clinic - Specialty Clinic
Type
Critical Access Hospital
340B ID
CAH191306-02
Entity Address
10289 Gould Dr. Suite C
ST FRANCISIVLLE, LA 70775
Medicare Provider Number
191306
Outpatient Facility Provider Number
Participating Start Date
1/1/2023
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0428
Pharmacy Address
5801 MAIN STREET
ZACHARY, LA 70791
Pharmacy Comments
Contract Details
Approval Date
3/20/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ledoux Chastant, CEO
(225) 635-2441
Contract Pharmacy Representative
West Feliciana Parish Hospital
LINDA HARVEY, CFO
(225) 635-2411
Signed By Date
3/20/2023
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