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WINN DIXIE PHARMACY #1501
CAH191313-00 RIVERSIDE MEDICAL CENTER
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Covered Entity Details
Entity Name
RIVERSIDE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191313-00
Entity Address
1900 MAIN STREET
FRANKLINTON, LA 70438-3688
Medicare Provider Number
191313
Participating Start Date
9/21/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WINN DIXIE PHARMACY #1501
Pharmacy Address
731 WASHINGTON STREET
FRANKLINTON, LA 70438
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/10/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Peter J. Sullivan, CEO
(985) 839-4431 Ext: 4180
Contract Pharmacy Representative
SE Grocers
Scott Wink, Director, Pharmacy Managed Care
(904) 370-7776
Signed By Date
1/17/2023
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