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WAL-MART PHARMACY 10-0542
DSH190008 Hospital Service District No. 1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System
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Covered Entity Details
Entity Name
Hospital Service District No. 1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190008
Entity Address
8166 MAIN STREET
HOUMA, LA 70360
Medicare Provider Number
190008
Participating Start Date
10/1/2007
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0542
Pharmacy Address
1633 MARTIN LUTHER KING BLVD
HOUMA, LA 70360
Pharmacy Comments
Contract Details
Approval Date
4/18/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
FRANCES DIANE YEATES, COO
(985) 873-4605
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/18/2023
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