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WAL-MART PHARMACY 10-0505
DSH190133 ALLEN PARISH HOSPITAL
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Covered Entity Details
Entity Name
ALLEN PARISH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190133
Entity Address
108 6th Ave
KINDER, LA 70648
Medicare Provider Number
190133
Participating Start Date
10/1/2017
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0505
Pharmacy Address
1125 N PINE
DE RIDDER, LA 70634
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jacqueline Reviel, Allen Parish Hospital CEO
(337) 738-9479
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/14/2025
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