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LOUISIANA CVS PHARMACY, L.L.C.
DSH190017 OPELOUSAS GENERAL HOSPITAL
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Covered Entity Details
Entity Name
OPELOUSAS GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190017
Entity Address
539 EAST PRUDHOMME ST
OPELOUSAS, LA 70570
Medicare Provider Number
190017
Participating Start Date
4/1/2003
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05554
111 WESTGATE RD.
LAFAYETTE, LA 70506
Pharmacy Comments
Contract Details
Approval Date
10/11/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/6/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jim Juneau, CFO
(337) 948-5133
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/11/2018
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