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WAL-MART PHARMACY 10-0876
CH062350 IBERIA COMPRHESIVE COM HEALTH CNTR, INC.
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Covered Entity Details
Entity Name
IBERIA COMPRHESIVE COM HEALTH CNTR, INC.
Subdivision Name
IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH062350
Entity Address
806 Jefferson Ter
New Iberia, LA 70560-5727
Grant Number
H80CS00697
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
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
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RODERICK C. CAMPBELL, CEO
(337) 365-4945 Ext: 128
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/16/2017
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