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WALGREEN CO.
DSH190312 OUR LADY OF THE ANGELS HOSPITAL
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Covered Entity Details
Entity Name
OUR LADY OF THE ANGELS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190312
Entity Address
433 Plaza Street
BOGALUSA, LA 70427
Medicare Provider Number
190312
Participating Start Date
4/1/2015
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10273
2209 HIGHWAY 11 NORTH
PICAYUNE, MS 39466-2065
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
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
Brooke Cummings, VP Finance
(985) 730-7040
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2022
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