Contract Pharmacy Details

LOUISIANA CVS PHARMACY, L.L.C.
DSH190274 OCHSNER MEDICAL CENTER - KENNER

Covered Entity Details

Entity Name

OCHSNER MEDICAL CENTER - KENNER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190274

Entity Address

180 WEST ESPLANADE AVE.
KENNER, LA 70065

Medicare Provider Number

190274

Participating Start Date

7/1/2008

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

LOUISIANA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05442
12589 AIRLINE HWY
DESTREHAN, LA 70047

Pharmacy Comments

Contract Details

Approval Date

1/15/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Mark Eckert, CFO
(504) 464-8059

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/15/2020

340B Drug Pricing Program Database