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BIOPLUS SPECIALTY PHARMACY LA, LLC
CAH191304-00 NORTH CADDO MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTH CADDO MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191304-00
Entity Address
815 South Pine
VIVIAN, LA 71082
Medicare Provider Number
191304
Participating Start Date
7/1/2016
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
BIOPLUS SPECIALTY PHARMACY LA, LLC
Pharmacy Address
2731 MANHATTAN BLVD STE B17
HARVEY, LA 70058
Pharmacy Comments
Contract Details
Approval Date
4/16/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Jones, CEO
(318) 375-4001
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/16/2021
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