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WALGREEN CO
DSH190046 TOURO INFIRMARY
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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
WALGREEN CO
Pharmacy Address
710 OVILLA ROAD
WAXAHACHIE, TX 75167
Pharmacy Comments
08/15/2012 Distribution Center
Contract Details
Approval Date
2/11/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/27/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James T. Montgomery, President/CEO
(504) 897-8246
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2013
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