340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
DSH190208 EAST CARROLL PARISH HOSPITAL
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Covered Entity Details
Entity Name
EAST CARROLL PARISH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190208
Entity Address
336 NORTH HOOD STREET
LAKE PROVIDENCE, LA 71254
Medicare Provider Number
190208
Participating Start Date
4/1/2020
Last Recertification Date
9/12/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LaDonna Englerth, Administrator
(318) 559-4023 Ext: 103
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/12/2023
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