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WAL-MART PHARMACY 10-5022
DSH190039 WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER
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Covered Entity Details
Entity Name
WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190039
Entity Address
1101 MEDICAL CENTER BLVD
MARRERO, LA 70072
Medicare Provider Number
190039
Participating Start Date
11/25/2005
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5022
Pharmacy Address
1901 TCHOPITOULAS STREET
NEW ORLEANS, LA 70130
Pharmacy Comments
Contract Details
Approval Date
7/10/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/16/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dodie McElmurray, COO
(504) 349-6021
Contract Pharmacy Representative
West Jefferson Medical Center - Marrero, LA
April E. Higdon, Director of Pharmacy
(504) 349-1711
Signed By Date
7/10/2019
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