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LOUISIANA CVS PHARMACY, L.L.C.
DSH190011 BRFHH Monroe LLC d/b/a Ochsner LSU Health Monroe
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Covered Entity Details
Entity Name
BRFHH Monroe LLC d/b/a Ochsner LSU Health Monroe
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190011
Entity Address
4864 JACKSON STREET
MONROE, LA 71202
Medicare Provider Number
190011
Participating Start Date
1/1/1998
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05513
1710 LOUISVILLE AVE.
MONROE, LA 71201
Pharmacy Comments
Contract Details
Approval Date
1/18/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark A Randolph, CEO
(318) 584-2569
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/18/2021
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