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WAL-MART PHARMACY 10-0543
STD70577 Acadiana Practitioners LLC
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Covered Entity Details
Entity Name
Acadiana Practitioners LLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD70577
Entity Address
414 Saizan Ave
Port Barre, LA 70577
Grant Number
NH25PS005176
Participating Start Date
11/13/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0543
Pharmacy Address
1629 EAST CRESSWELL LANE
OPELOUSAS, LA 70570
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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