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WAL-MART PHARMACY 10-1109
CAH191323-00 Hospital Service District 1A, Parish of Richland, State of Louisiana, DBA Richland Parish Hospital
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Covered Entity Details
Entity Name
Hospital Service District 1A, Parish of Richland, State of Louisiana, DBA Richland Parish Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191323-00
Entity Address
407 Cincinnati Street
Delhi, LA 71232-3008
Medicare Provider Number
191323
Participating Start Date
7/1/2014
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1109
Pharmacy Address
1806 S JULIA ST
RAYVILLE, LA 71269
Pharmacy Comments
Contract Details
Approval Date
10/16/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/8/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Carroll, CEO
(318) 878-6323
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/16/2014
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