340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
IDEAL HEALTH MART PHARMACY, INC
DSH190050 BEAUREGARD MEMORIAL HOSPITAL INC.
Print
Covered Entity Details
Entity Name
BEAUREGARD MEMORIAL HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190050
Entity Address
600 S. PINE STREET
DERIDDER, LA 70634
Medicare Provider Number
190050
Participating Start Date
10/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
IDEAL HEALTH MART PHARMACY, INC
Pharmacy Address
610 N PINE ST
DERIDDER, LA 70634
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
10/20/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/9/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jarred Veillon, Chief Financial Officer
(337) 462-7495
Contract Pharmacy Representative
IDEAL HEALTH MART PHARMACY
Kesa Lane, Pharmacy Manager
(337) 463-7210
Signed By Date
10/14/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session