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WALGREEN LOUISIANA CO., INC.
PED193300-00 Children's Hospital
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Covered Entity Details
Entity Name
Children's Hospital
Subdivision Name
Type
Children's Hospital
340B ID
PED193300-00
Entity Address
200 HENRY CLAY AVENUE
NEW ORLEANS, LA 70118
Medicare Provider Number
193300
Participating Start Date
1/1/2014
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS # 05382
4330 HWY 22
MANDEVILLE, LA 70471
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John R Nickens, President & CEO
(504) 896-9452
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2020
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