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LCMC HEALTH PHARMACY SERVICES, LLC
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
LCMC HEALTH PHARMACY SERVICES, LLC
Pharmacy Address
200 HENRY CLAY AVE STE 2107
NEW ORLEANS, LA 70118
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen Matthew Baldwin, Chief Operating Officer
(504) 897-8566
Contract Pharmacy Representative
LCMC HEALTH PHARMACY SERVICES, LLC
ELIAS AYOUB, VP OF SPECIALTY PHARMACY
(504) 702-3188
Signed By Date
10/17/2022
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