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O'DONOVAN PHARMACY
DSH190102 OUR LADY OF LOURDES RMC
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Covered Entity Details
Entity Name
OUR LADY OF LOURDES RMC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190102
Entity Address
4801 AMBASSADOR CAFFERY PRKWY
LAFAYETTE, LA 70508
Medicare Provider Number
190102
Participating Start Date
1/1/2020
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
O'DONOVAN PHARMACY
Pharmacy Address
5131 ODONOVAN DR STE 402
BATON ROUGE, LA 70808-4792
Pharmacy Comments
6/27/2013 - OPA request to add DEA number.
Contract Details
Approval Date
4/1/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Crystal R Kiser, Manager
(337) 470-2131
Contract Pharmacy Representative
FMOLHS
Adria Kerr, Corporate Director of Retail
(225) 765-9014
Signed By Date
4/1/2022
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