Contract Pharmacy Details

WALGREEN LOUISIANA CO., INC.
CAH191304-00 NORTH CADDO MEDICAL CENTER

Covered Entity Details

Entity Name

NORTH CADDO MEDICAL CENTER

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH191304-00

Entity Address

815 South Pine
VIVIAN, LA 71082

Medicare Provider Number

191304

Participating Start Date

7/1/2016

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

WALGREEN LOUISIANA CO., INC.

Pharmacy Address

DBA: WALGREENS # 09492
3100 N MARKET ST
SHREVEPORT, LA 71107-4005

Pharmacy Comments

Contract Details

Approval Date

7/9/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

David Jones, CEO
(318) 375-4001

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/9/2020

340B Drug Pricing Program Database