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WAL-MART PHARMACY 10-5315
STD705701 Acadiana Practitioners LLC
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Covered Entity Details
Entity Name
Acadiana Practitioners LLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD705701
Entity Address
1119 Prudhomme Circle
Opelousas, LA 70570
Grant Number
NH25PS005176
Participating Start Date
11/13/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
4/9/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rhonda Bergeron, CEO
(337) 447-4027
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
4/9/2025
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