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WALGREEN LOUISIANA CO., INC.
DSH190054 IBERIA MEDICAL CENTER
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Covered Entity Details
Entity Name
IBERIA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190054
Entity Address
2315 EAST MAIN STREET
NEW IBERIA, LA 70560
Medicare Provider Number
190054
Participating Start Date
7/1/2004
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS #13134
6130 JOHNSTON ST.
LAFAYETTE, LA 70503
Pharmacy Comments
Contract Details
Approval Date
4/19/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/8/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Amy Langlinais, CFO
(337) 374-7104
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/19/2023
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