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WALGREEN LOUISIANA CO., INC.
DSH190116 MOREHOUSE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MOREHOUSE GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190116
Entity Address
323 WEST WALNUT
BASTROP, LA 71220
Medicare Provider Number
190116
Participating Start Date
1/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
WALGREENS #17055
2323 FORSYTHE AVE
MONROE, LA 71201-2936
Pharmacy Comments
Contract Details
Approval Date
1/11/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Derrick Frazier, Chief Executive Officer
(318) 283-3601
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/11/2022
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