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WALMART PHARMACY 10-5169
DSH190145 LASALLE GENERAL HOSPITAL INC.
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Covered Entity Details
Entity Name
LASALLE GENERAL HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190145
Entity Address
187 Ninth Street
JENA, LA 71342
Medicare Provider Number
190145
Participating Start Date
7/1/2019
Last Recertification Date
9/5/2024
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
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lana Francis, Chief Executive Officer
(318) 992-9154
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/12/2023
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