Contract Pharmacy Details

LOUISIANA CVS PHARMACY, L.L.C.
DSH190046 TOURO INFIRMARY

Covered Entity Details

Entity Name

TOURO INFIRMARY

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190046

Entity Address

1401 FOUCHER STREET
NEW ORLEANS, LA 70115

Medicare Provider Number

190046

Participating Start Date

4/1/2006

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

LOUISIANA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05503
4901 PRYTANIA ST
NEW ORLEANS, LA 70115

Pharmacy Comments

Contract Details

Approval Date

11/29/2012

Contract Begin Date

1/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/17/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

James T. Montgomery, President/CEO
(504) 897-8246

Contract Pharmacy Representative

CVS
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762

Signed By Date

10/15/2012

340B Drug Pricing Program Database