Contract Pharmacy Details

WALGREEN LOUISIANA CO., INC.
DSH190125 ST FRANCIS MEDICAL CENTER, INC

Covered Entity Details

Entity Name

ST FRANCIS MEDICAL CENTER, INC

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190125

Entity Address

309 JACKSON STREET
MONROE, LA 71201

Medicare Provider Number

190125

Participating Start Date

4/1/2006

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

WALGREEN LOUISIANA CO., INC.

Pharmacy Address

DBA: WALGREENS # 10536
1930 E MADISON AVE
BASTROP, LA 71220-4034

Pharmacy Comments

Contract Details

Approval Date

7/14/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/24/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jeremy Rogers, VP, Chief Financial Officer
(337) 470-2147

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/14/2022

340B Drug Pricing Program Database