Contract Pharmacy Details

LOUISIANA CVS PHARMACY, L.L.C.
DSH190039 WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER

Covered Entity Details

Entity Name

WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190039

Entity Address

1101 MEDICAL CENTER BLVD
MARRERO, LA 70072

Medicare Provider Number

190039

Participating Start Date

11/25/2005

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

LOUISIANA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05599
1600 LAPALCO BLVD.
HARVEY, LA 70058

Pharmacy Comments

Contract Details

Approval Date

4/14/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Robert Eli Smith, Chief Operating Officer—West Jefferson Medical Center
(504) 349-1105

Contract Pharmacy Representative

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

Signed By Date

4/14/2020

340B Drug Pricing Program Database