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Walmart Pharmacy 10-7611
STD70506 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
STD70506
Entity Address
2730 Ambassador Caffery Parkway
Lafayette, LA 70506
Grant Number
NH25PS005176
Participating Start Date
4/1/2025
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
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
4/15/2025
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