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MEDI THRIFT DRUGS
DSH190145 LASALLE GENERAL HOSPITAL INC.
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Covered Entity Details
Entity Name
LASALLE GENERAL HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190145
Entity Address
187 Ninth Street
JENA, LA 71342
Medicare Provider Number
190145
Participating Start Date
7/1/2019
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
MEDI THRIFT DRUGS
Pharmacy Address
302 BUSHLEY ST
P.O. BOX 205
HARRISONBURG, LA 71340
Pharmacy Comments
Contract Details
Approval Date
7/3/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lana Francis, Chief Executive Officer
(318) 992-9154
Contract Pharmacy Representative
Medi Thrift Drugs
John J. Costanza, President
(318) 744-5351
Signed By Date
7/3/2019
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