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WALMART PHARMACY 10-5169
CAH191308-00 West Ascension Parish Hospital (d/b/a Prevost Memorial Hospital)
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Covered Entity Details
Entity Name
West Ascension Parish Hospital (d/b/a Prevost Memorial Hospital)
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191308-00
Entity Address
301 MEMORIAL DRIVE
DONALDSONVILLE, LA 70346
Medicare Provider Number
191308
Participating Start Date
1/1/2019
Last Recertification Date
12/4/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/11/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shelton Anthony, CEO
(225) 474-2114
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
4/11/2025
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