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WAL-MART PHARMACY 10-1128
CAH191311-00 HOSPITAL SERVICE DISTRICT #1, PARISH OF AVOYELLES, STATE OF LOUISIANA DBA BUNKIE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
HOSPITAL SERVICE DISTRICT #1, PARISH OF AVOYELLES, STATE OF LOUISIANA DBA BUNKIE GENERAL HOSPITAL
Subdivision Name
HOSPITAL SERVICE DISTRICT #1
Type
Critical Access Hospital
340B ID
CAH191311-00
Entity Address
427 EVERGREEN STREET
BUNKIE, LA 71322
Medicare Provider Number
191311
Participating Start Date
9/20/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1128
Pharmacy Address
7162 HWY 1
MARKSVILLE, LA 71351
Pharmacy Comments
Contract Details
Approval Date
4/10/2012
Contract Begin Date
4/10/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/29/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
LINDA DEVILLE, CHIEF EXECUTIVE OFFICER
(318) 346-6681 Ext: 233
Contract Pharmacy Representative
Wal--Mart
Marcus Osborne, Sales & Contracting
(479) 204-8452
Signed By Date
3/30/2012
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