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WALMART PHARMACY 10-5169
DSH190034 ABBEVILLE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
ABBEVILLE GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190034
Entity Address
118 NORTH HOSPITAL DRIVE
ABBEVILLE, LA 70510
Medicare Provider Number
190034
Participating Start Date
9/15/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/6/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wendy S. Broussard, Compliance/Privacy Officer
(337) 898-6112
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/6/2023
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