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M AND W COVINGTON LLC
DSH190045 ST. TAMMANY PARISH HOSPITAL
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Covered Entity Details
Entity Name
ST. TAMMANY PARISH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190045
Entity Address
St. Tammany Parish Hospital
1202 S. Tyler Street
COVINGTON, LA 70433
Medicare Provider Number
190045
Participating Start Date
10/1/2018
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
M AND W COVINGTON LLC
Pharmacy Address
DBA BRASWELL DRUGS
1107 S TYLER ST
COVINGTON, LA 70433
Pharmacy Comments
Contract Details
Approval Date
10/5/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/15/2023
Ownership change
Contacts
Covered Entity Signing Official
Sandra DiPietro, Senior Vice President/Chief Financial Officer
(985) 898-4583
Contract Pharmacy Representative
M and W Covington
Chris Martin, Owner
(256) 831-6116
Signed By Date
10/5/2022
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