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HEALTH MART PHARMACY OF LAFAYETTE
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
HEALTH MART PHARMACY OF LAFAYETTE
Pharmacy Address
600 JOHNSTON ST
LAFAYETTE, LA 70501-8060
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Katherine Hebert, Chief Executive Officer
(337) 261-6004
Contract Pharmacy Representative
Health Mart of Lafayette
Kitty L Trahan, COO
(337) 230-1567
Signed By Date
4/15/2021
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