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WAL-MART PHARMACY 10-0976
DSH190151 RICHARDSON MEDICAL CENTER
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Covered Entity Details
Entity Name
RICHARDSON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190151
Entity Address
254 HWY 3048
RAYVILLE, LA 71269
Medicare Provider Number
190151
Participating Start Date
7/1/2005
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0976
Pharmacy Address
3360 FRONT STREET
WINNSBORO, LA 71295
Pharmacy Comments
Contract Details
Approval Date
2/26/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/18/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James Barrett, CEO
(318) 728-8389
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/25/2013
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