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WALGREEN LOUISIANA CO., INC.
DSH190019 CHRISTUS ST FRANCES CABRINI HOSPITAL
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Covered Entity Details
Entity Name
CHRISTUS ST FRANCES CABRINI HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190019
Entity Address
3330 MASONIC DRIVE
ALEXANDRIA, LA 71301
Medicare Provider Number
190019
Participating Start Date
4/1/2006
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS #10537
916 N. PINE ST.
DERIDDER, LA 70634-2816
Pharmacy Comments
Contract Details
Approval Date
10/25/2012
Contract Begin Date
10/25/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephen F. Wright, President and CEO
(318) 448-6701
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/10/2012
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