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VITAL RX LLC
DSH190050 BEAUREGARD MEMORIAL HOSPITAL INC.
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Covered Entity Details
Entity Name
BEAUREGARD MEMORIAL HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190050
Entity Address
600 S. PINE STREET
DERIDDER, LA 70634
Medicare Provider Number
190050
Participating Start Date
10/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
VITAL RX LLC
Pharmacy Address
237 CAHABA VALLEY PARKWAY
PELHAM, AL 35124
Pharmacy Comments
Contract Details
Approval Date
7/13/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jarred Veillon, Chief Financial Officer
(337) 462-7495
Contract Pharmacy Representative
VitalRx
Bobby Wamble, COO
(256) 260-3350
Signed By Date
7/13/2022
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