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BATON ROUGE GENERAL COMPOUNDING PHARMACY
DSH190065 BATON ROUGE GENERAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BATON ROUGE GENERAL MEDICAL CENTER
Subdivision Name
Mid City
Type
Disproportionate Share Hospital
340B ID
DSH190065
Entity Address
8585 Picardy Ave.
BATON ROUGE, LA 70809
Medicare Provider Number
190065
Participating Start Date
9/16/2005
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
BATON ROUGE GENERAL COMPOUNDING PHARMACY
Pharmacy Address
3600 FLORIDA BLVD
BATON ROUGE, LA 70806
Pharmacy Comments
Contract Details
Approval Date
10/13/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/28/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kendall Johnson, CFO
(225) 237-1645
Contract Pharmacy Representative
Michael Dorman, Director of Pharmacy
(225) 381-6066
Signed By Date
10/13/2015
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