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LEE ROAD FAMILY PHARMACY INC.
DSH190045 ST. TAMMANY PARISH HOSPITAL
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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
LEE ROAD FAMILY PHARMACY INC.
Pharmacy Address
19705 HIGHWAY 40
COVINGTON, LA 70435-7043
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sandra DiPietro, Senior Vice President/Chief Financial Officer
(985) 898-4583
Contract Pharmacy Representative
Lee Road Family Pharmacy
Earl Williams, Owner
(504) 382-8461
Signed By Date
10/12/2021
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