Contract Pharmacy Details

WINN DIXIE PHARMACY #1443
DSH190045 ST. TAMMANY PARISH HOSPITAL

Covered Entity Details

Entity Name

ST. TAMMANY PARISH HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190045

Entity Address

St. Tammany Parish Hospital
1202 S. Tyler Street
COVINGTON, LA 70433

Medicare Provider Number

190045

Participating Start Date

10/1/2018

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

WINN DIXIE PHARMACY #1443

Pharmacy Address

70431 HWY 21
COVINGTON, LA 70433

Pharmacy Comments

Contract Details

Approval Date

7/16/2021

Contract Begin Date

7/26/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/12/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Sandra DiPietro, Senior Vice President/Chief Financial Officer
(985) 898-4583

Contract Pharmacy Representative

Southeastern Grocers LLC
Michael LeBlanc, Sr.Director, Pharmacy
(904) 783-5897

Signed By Date

7/16/2021

340B Drug Pricing Program Database