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Walmart Pharmacy 10-7611
CHC26579-02 C A S S E DENTAL HEALTH INSTITUTE
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Covered Entity Details
Entity Name
C A S S E DENTAL HEALTH INSTITUTE
Subdivision Name
CASSE-Bert Kouns Site
Type
HRSA-Funded Health Center
340B ID
CHC26579-02
Entity Address
2120 Bert Kouns
Ste. A
Shreveport, LA 71118-3354
Grant Number
H80CS26579
Participating Start Date
7/1/2018
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/25/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Beth Chumley, CEO
(318) 688-3350
Contract Pharmacy Representative
Walmart
Lisa Foster, Director of Business Development, Health & Wellness, 340B
(717) 404-8368
Signed By Date
4/25/2025
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