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WALGREEN LOUISIANA CO., INC.
DSH190039 WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER
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Covered Entity Details
Entity Name
WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190039
Entity Address
1101 MEDICAL CENTER BLVD
MARRERO, LA 70072
Medicare Provider Number
190039
Participating Start Date
11/25/2005
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS #15200
2001 CAROL SUE AVE
GRETNA, LA 70056-4445
Pharmacy Comments
Contract Details
Approval Date
6/15/2010
Contract Begin Date
6/15/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
5/28/2010
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