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Walgreens #21373
CAH191304-00 NORTH CADDO MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTH CADDO MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191304-00
Entity Address
815 South Pine
VIVIAN, LA 71082
Medicare Provider Number
191304
Participating Start Date
7/1/2016
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
Walgreens #21373
Pharmacy Address
Walgreens Central Fill #21373
4100 Dale Earnhardt Way
STE 200
Northlake, TX 76262
Pharmacy Comments
Contract Details
Approval Date
7/11/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Jones, CEO
(318) 375-4001
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/11/2022
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