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LOUISIANA CVS PHARMACY, L.L.C.
CAH191325-00 LAFOURCHE HOSPITAL SERVICE DISTRICT #1 DBA LADY OF THE SEA GENERAL HOSPITAL
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Covered Entity Details
Entity Name
LAFOURCHE HOSPITAL SERVICE DISTRICT #1 DBA LADY OF THE SEA GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191325-00
Entity Address
200 WEST 134TH PLACE
CUT OFF, LA 70345
Medicare Provider Number
191325
Participating Start Date
9/14/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05297
201 N. CANAL BLVD.
THIBODAUX, LA 70301
Pharmacy Comments
Contract Details
Approval Date
4/8/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen S. Collins, C.E.O.
(985) 632-8286
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/8/2019
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