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WALGREEN LOUISIANA CO., INC.
DSH190013 WEST CALCASIEU-CAMERON HOSPITAL
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Covered Entity Details
Entity Name
WEST CALCASIEU-CAMERON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190013
Entity Address
701 EAST CYPRESS
SULPHUR, LA 70663
Medicare Provider Number
190013
Participating Start Date
10/1/2018
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS # 07197
120 N HIGHWAY 171
MOSS BLUFF, LA 70611-5343
Pharmacy Comments
Contract Details
Approval Date
7/8/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jobie James, Chief Financial Officer
(337) 527-4143
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/8/2022
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