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LOUISIANA CVS PHARMACY, L.L.C.
DSH190133 ALLEN PARISH HOSPITAL
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Covered Entity Details
Entity Name
ALLEN PARISH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190133
Entity Address
108 6th Ave
KINDER, LA 70648
Medicare Provider Number
190133
Participating Start Date
10/1/2017
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05455
1269 SAM HOUSTON JONES PKWY
LAKE CHARLES, LA 70611
Pharmacy Comments
Contract Details
Approval Date
7/10/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jacqueline Reviel, Allen Parish Hospital CEO
(337) 738-9479
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/10/2020
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