Contract Pharmacy Details

LOUISIANA CVS PHARMACY, L.L.C.
DSH190015 North Oaks Medical Center LLC

Covered Entity Details

Entity Name

North Oaks Medical Center LLC

Subdivision Name

DBA NORTH OAKS MEDICAL CENTER LLC

Type

Disproportionate Share Hospital

340B ID

DSH190015

Entity Address

15790 PAUL VEGA M.D. DRIVE
HAMMOND, LA 70403

Medicare Provider Number

190015

Participating Start Date

4/1/2005

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

LOUISIANA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05294
285 WEST PINE
PONCHATOULA, LA 70454

Pharmacy Comments

Contract Details

Approval Date

1/9/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/18/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

SHIRLEY HSING, CFO
(985) 230-6655

Contract Pharmacy Representative

CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467

Signed By Date

1/9/2014

340B Drug Pricing Program Database