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WAL-MART PHARMACY 10-0098
DSH190116 MOREHOUSE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MOREHOUSE GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190116
Entity Address
323 WEST WALNUT
BASTROP, LA 71220
Medicare Provider Number
190116
Participating Start Date
1/1/2005
Last Recertification Date
8/19/2024
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
4/24/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/28/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephen R. Pitts, Chief Executive Officer
(318) 283-3600
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/24/2014
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