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WAL-MART PHARMACY 10-0876
SCH190007-00 NATCHITOCHES REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
NATCHITOCHES REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH190007-00
Entity Address
501 KEYSER AVE
NATCHITOCHES, LA 71457
Medicare Provider Number
190007
Participating Start Date
9/7/2010
Last Recertification Date
9/13/2022
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0876
Pharmacy Address
25800 HWY 171
MANY, LA 71449
Pharmacy Comments
7/25/12-changed from Highway 17
Contract Details
Approval Date
4/13/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Damian K. Soileau, CEO
(318) 214-4512
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/13/2017
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