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VANDERBILT HEALTH PHARMACY GROUP
DSH190065 BATON ROUGE GENERAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BATON ROUGE GENERAL MEDICAL CENTER
Subdivision Name
Mid City
Type
Disproportionate Share Hospital
340B ID
DSH190065
Entity Address
8585 Picardy Ave.
BATON ROUGE, LA 70809
Medicare Provider Number
190065
Participating Start Date
9/16/2005
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
VANDERBILT HEALTH PHARMACY GROUP
Pharmacy Address
718 MELROSE AVE
NASHVILLE, TN 37211-3721
Pharmacy Comments
Contract Details
Approval Date
10/10/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kendall Johnson, CFO
(225) 237-1645
Contract Pharmacy Representative
VANDERBILT HEALTH PHARMACY GROUP
CORA B SMITH, DIRECTOR OF OPERATIONS AND PHARMACY SERVICES
(901) 318-2098
Signed By Date
10/10/2019
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