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WALGREEN LOUISIANA CO., INC.
DSH190098 University Health Shreveport, LLC
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Covered Entity Details
Entity Name
University Health Shreveport, LLC
Subdivision Name
UNIVERSITY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH190098
Entity Address
1541 KINGS HIGHWAY
SHREVEPORT, LA 71103
Medicare Provider Number
190098
Participating Start Date
1/1/1998
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
WALGREENS #17338
761 PIERREMONT RD
SHREVEPORT, LA 71106-2211
Pharmacy Comments
Contract Details
Approval Date
4/19/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Vernon Moore, Chief Financial Officer
(318) 626-0990
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/19/2022
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