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WAL-MART PHARMACY 10-0531
STD703801 Cardiovascular Institute of the South
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Covered Entity Details
Entity Name
Cardiovascular Institute of the South
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD703801
Entity Address
1231 David Drive
Morgan City, LA 70380
Grant Number
NH25PS005176
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0531
Pharmacy Address
3142 AMBASSADOR CAFFERY PKWY
LAFAYETTE, LA 70506
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ryan Hebert, CEO
(985) 873-5670
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
4/14/2025
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