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BATON ROUGE GENERAL CORNER 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 CORNER PHARMACY
Pharmacy Address
8585 PICARDY AVE
BATON ROUGE, LA 70809
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
4/27/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kendall Johnson, CFO
(225) 237-1645
Contract Pharmacy Representative
Pam Nogueira, Pharmacy Mgr., Outpatient Retail
(225) 381-6994
Signed By Date
4/17/2017
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