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WAL-MART PHARMACY 10-0149
CAH191301-00 UNION GENERAL HOSPITAL
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Covered Entity Details
Entity Name
UNION GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191301-00
Entity Address
901 JAMES AVE
FARMERVILLE, LA 71241
Medicare Provider Number
191301
Participating Start Date
4/1/2014
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0149
Pharmacy Address
184 OLD WINFIELD RD.
JONESBORO, LA 71251
Pharmacy Comments
Contract Details
Approval Date
7/1/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/13/2015
Agreement registered in error
Contacts
Covered Entity Signing Official
EVALYN ORMOND, CEO
(318) 368-7090
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/1/2014
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