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LOUISIANA CVS PHARMACY, L.L.C.
DSH190006 UNIVERSITY HOSPITAL AND CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL AND CLINICS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190006
Entity Address
2390 W CONGRESS ST.
LAFAYETTE, LA 70506
Medicare Provider Number
190006
Participating Start Date
1/1/1998
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01579
6800 JOHNSTON ST.
LAFAYETTE, LA 70503
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Katherine Hebert, Chief Executive Officer
(337) 261-6004
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2020
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