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MEDIC SHOP PHARMACY
DSH190045 ST. TAMMANY PARISH HOSPITAL
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Covered Entity Details
Entity Name
ST. TAMMANY PARISH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190045
Entity Address
St. Tammany Parish Hospital
1202 S. Tyler Street
COVINGTON, LA 70433
Medicare Provider Number
190045
Participating Start Date
10/1/2018
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
MEDIC SHOP PHARMACY
Pharmacy Address
1000 BUSINESS 190
STE 4
COVINGTON, LA 70433
Pharmacy Comments
Contract Details
Approval Date
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Sandra DiPietro, Senior Vice President/Chief Financial Officer
(985) 898-4583
Contract Pharmacy Representative
The Medic Shop
Susan Millen, Owner
(985) 875-7515
Signed By Date
4/12/2023
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