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WAL-MART PHARMACY 10-1106
CH06248A CATAHOULA PARISH HOSPITAL DISTRICT # 2
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Covered Entity Details
Entity Name
CATAHOULA PARISH HOSPITAL DISTRICT # 2
Subdivision Name
Catahoula Parish Hospital District No 2 Administrative Service Site
Type
HRSA-Funded Health Center
340B ID
CH06248A
Entity Address
710 CHISUM STREET
SICILY ISLAND, LA 71368
Grant Number
H80CS00206
Participating Start Date
7/1/2017
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1106
Pharmacy Address
4283 CARTER STREET
VIDALIA, LA 71373
Pharmacy Comments
Contract Details
Approval Date
10/10/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Debra K. Miesch, CEO
(318) 389-5727 Ext: 1407
Contract Pharmacy Representative
Walmart
Christian Nava, Senior Manager, Program Development-340B
(210) 632-0647
Signed By Date
10/10/2024
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