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WALGREEN LOUISIANA CO., INC.
DSH190125 ST FRANCIS MEDICAL CENTER, INC
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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
WALGREENS #17055
2323 FORSYTHE AVE
MONROE, LA 71201-2936
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
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