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ACCREDO HEALTH GROUP INC
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
ACCREDO HEALTH GROUP INC
Pharmacy Address
2040 W RIO SALADO PKWY STE 101B
TEMPE, AZ 85281-2010
Pharmacy Comments
Contract Details
Approval Date
7/7/2022
Contract Begin Date
10/1/2022
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
7/7/2022
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