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CVS PHARMACY, INC.
DSH190013D WEST CALCASIEU-CAMERON HOSPITAL
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Covered Entity Details
Entity Name
WEST CALCASIEU-CAMERON HOSPITAL
Subdivision Name
W CALCASIEU CAMERON HOSP JOHNSON - Johnson Bayou Rural Health Clinic
Type
Disproportionate Share Hospital
340B ID
DSH190013D
Entity Address
6240 GULF BEACH HIGHWAY
JOHNSON BAYOU, LA 70631-4213
Medicare Provider Number
190013
Outpatient Facility Provider Number
193479
Participating Start Date
10/1/2018
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 06381
2425 N. 16TH ST.
ORANGE, TX 77630
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
Jobie James, Chief Financial Officer
(337) 527-4143
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2020
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