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WAL-MART PHARMACY 10-0541
DSH190040 Slidell Memorial Hospital
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Covered Entity Details
Entity Name
Slidell Memorial Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190040
Entity Address
1001 Gause Boulevard
Slidell, LA 70458-2987
Medicare Provider Number
190040
Participating Start Date
10/1/2011
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0541
Pharmacy Address
880 NORTH HWY 190
COVINGTON, LA 70433
Pharmacy Comments
Contract Details
Approval Date
7/22/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bill Davis, Chief Executive Officer
(985) 280-8504
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/22/2014
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