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LOUISIANA CVS PHARMACY, L.L.C.
DSH190039 WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER
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Covered Entity Details
Entity Name
WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190039
Entity Address
1101 MEDICAL CENTER BLVD
MARRERO, LA 70072
Medicare Provider Number
190039
Participating Start Date
11/25/2005
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05528
1313 PAUL MAILLARD RD/PO BOX 50
LULING, LA 70070
Pharmacy Comments
Contract Details
Approval Date
7/9/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/5/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Robert Eli Smith, Chief Operating Officer—West Jefferson Medical Center
(504) 349-1105
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/9/2021
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