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WAL-MART PHARMACY 10-0828
CH062480 CATAHOULA PARISH HOSPITAL DISTRICT # 2
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Covered Entity Details
Entity Name
CATAHOULA PARISH HOSPITAL DISTRICT # 2
Subdivision Name
ISLAND MEDICAL & DENTAL
Type
HRSA-Funded Health Center
340B ID
CH062480
Entity Address
307 Chisum St
Sicily Island, LA 71368
Grant Number
H80CS00206
Participating Start Date
1/1/1999
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0828
Pharmacy Address
2373 E MAIN STREET
PLAINFIELD, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/26/2024
Agreement registered in error
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
10/15/2024
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