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WINN DIXIE PHARMACY #1472
DSH190313 NEW ORLEANS EAST HOSPITAL
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Covered Entity Details
Entity Name
NEW ORLEANS EAST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190313
Entity Address
5620 READ BOULEVARD
NEW ORLEANS, LA 70127
Medicare Provider Number
190313
Participating Start Date
7/1/2017
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WINN DIXIE PHARMACY #1472
Pharmacy Address
401 N. CARROLLTON AVE.
NEW ORLEANS, LA 70119-4702
Pharmacy Comments
Contract Details
Approval Date
7/13/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/13/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Anthony Saul, Chief Financial Officer
(504) 592-6610
Contract Pharmacy Representative
New Orleans East Hospital
Brandon Nguyen, Director of Pharmacy
(504) 592-6655
Signed By Date
7/13/2019
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