340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PONCHATOULA FAMILY PHARMACY
DSH190015 North Oaks Medical Center LLC
Print
Covered Entity Details
Entity Name
North Oaks Medical Center LLC
Subdivision Name
DBA NORTH OAKS MEDICAL CENTER LLC
Type
Disproportionate Share Hospital
340B ID
DSH190015
Entity Address
15790 PAUL VEGA M.D. DRIVE
HAMMOND, LA 70403
Medicare Provider Number
190015
Participating Start Date
4/1/2005
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
PONCHATOULA FAMILY PHARMACY
Pharmacy Address
19008 HIGHWAY 22
PONCHATOULA, LA 70454-6780
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2021
Ownership change
Contacts
Covered Entity Signing Official
Mark T Anderson, CFO
(985) 230-6602
Contract Pharmacy Representative
Albany Drugs
Lindsey Driscoll, Certified Pharmacy Technician
(225) 567-7772
Signed By Date
7/11/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session