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WINN DIXIE MONTGOMERY, LLC.
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
WINN DIXIE MONTGOMERY, LLC.
Pharmacy Address
WINN DIXIE PHARMACY # 1425
3645 LAPALCO BLVD
HARVEY, LA 70058
Pharmacy Comments
Contract Details
Approval Date
4/1/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Angela Greener, Chief Administrrative Letter
(504) 349-6021
Contract Pharmacy Representative
Curtis Hartin, Director of Pharmacy Managed Care
(904) 370-7776
Signed By Date
4/1/2014
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