340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-0098
STD712541 Lake Providence Medical Clinic
Print
Covered Entity Details
Entity Name
Lake Providence Medical Clinic
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD712541
Entity Address
319 N. Hood Street
Lake Providence, LA 71254
Grant Number
NH25PS005176
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0098
Pharmacy Address
6091 MER ROUGE RD., HWY 165
BASTROP, LA 71220
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
11/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Amanda D Grey, COO
(318) 428-3237
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
10/15/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session