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WALMART PHARMACY 10-5169
CAH191325-00 LAFOURCHE HOSPITAL SERVICE DISTRICT #1 DBA LADY OF THE SEA GENERAL HOSPITAL
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Covered Entity Details
Entity Name
LAFOURCHE HOSPITAL SERVICE DISTRICT #1 DBA LADY OF THE SEA GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191325-00
Entity Address
200 WEST 134TH PLACE
CUT OFF, LA 70345
Medicare Provider Number
191325
Participating Start Date
9/14/2010
Last Recertification Date
8/15/2024
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
4/8/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/26/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Karen S. Collins, C.E.O.
(985) 632-8286
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/8/2023
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