340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH191302-00 ST. MARTIN HOSPITAL
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Covered Entity Details
Entity Name
ST. MARTIN HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191302-00
Entity Address
210 CHAMPAGNE BLVD.
BREAUX BRIDGE, LA 70517
Medicare Provider Number
191302
Participating Start Date
9/28/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer L Vicknair, AVP - Nursing and Hospital Administration
(337) 909-2219
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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