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DRUG EMPORIUM
DSH190002 LAFAYETTE GENERAL MEDICAL CENTER
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Covered Entity Details
Entity Name
LAFAYETTE GENERAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190002
Entity Address
1214 COOLIDGE STREET
LAFAYETTE, LA 70503
Medicare Provider Number
190002
Participating Start Date
10/25/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
DRUG EMPORIUM
Pharmacy Address
GIBSON SALES, LP DBA DRUG EMPORIUM 220
505 BERTRAND DR
LAFAYETTE, LA 70506-5542
Pharmacy Comments
Contract Details
Approval Date
6/8/2011
Contract Begin Date
6/8/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/5/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
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