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WAL-MART PHARMACY 10-0773
DSH190044 ACADIA GENERAL HOSPITAL
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Covered Entity Details
Entity Name
ACADIA GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190044
Entity Address
1305 CROWLEY RAYNE HWY.
CROWLEY, LA 70526
Medicare Provider Number
190044
Participating Start Date
4/1/2011
Last Recertification Date
8/27/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0773
Pharmacy Address
1538 US HIGHWAY 190
EUNICE, LA 70535
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/2/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph James Mitchell, CEO
(337) 788-6400
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/15/2018
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