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WALGREEN LOUISIANA CO., INC.
RRC190027-00 ST. PATRICK HOSPITAL
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Covered Entity Details
Entity Name
ST. PATRICK HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC190027-00
Entity Address
524 DR. MICHAEL DEBAKEY DRIVE
LAKE CHARLES, LA 70601
Medicare Provider Number
190027
Participating Start Date
1/10/2022
Last Recertification Date
9/11/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS # 03373
2000 GERTSNER MEMORIAL DR
LAKE CHARLES, LA 70601-8060
Pharmacy Comments
Contract Details
Approval Date
1/18/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Trevino, CEO, CHRISTUS Health Southeast Texas
(409) 899-7102
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/18/2022
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