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WALGREEN LOUISIANA CO., INC.
DSH190007 NATCHITOCHES REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
NATCHITOCHES REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190007
Entity Address
501 KEYSER AVENUE
NATCHITOCHES, LA 71457
Medicare Provider Number
190007
Participating Start Date
10/1/2022
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS #12306
280 SAN ANTONIO AVENUE
MANY, LA 71449
Pharmacy Comments
Contract Details
Approval Date
9/14/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Damian K. Soileau, CEO
(318) 214-4512
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2022
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