340B Drug Pricing Program Database
WALGREEN LOUISIANA CO., INC.
PED193300-00 Children's Hospital - information as of 5/7/2025 11:09:34 PM
Covered Entity Details
Entity Name
Children's Hospital
Subdivision Name
Type
Children's Hospital
340B ID
PED193300-00
Entity Address
200 HENRY CLAY AVENUE
NEW ORLEANS, LA 70118
Medicare Provider Number
193300
Participating Start Date
1/1/2014
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS #15571
4501 AIRLINE DR.
METAIRIE, LA 70001
Pharmacy Comments
Contract Details
Approval Date
4/10/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lucio A. Fragoso, President & CEO
(504) 896-9452
Contract Pharmacy Representative
Walgreens
Ruthann Archer, Director of 340B Operations
(847) 964-8116
Signed By Date
4/10/2025
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