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OCHSNER PHARMACY AND WELLNESS- ST. ANNE
DSH190183 Southern Regional Medical Corporation d/b/a Leonard J. Chabert Medical Center
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Covered Entity Details
Entity Name
Southern Regional Medical Corporation d/b/a Leonard J. Chabert Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190183
Entity Address
1978 INDUSTRIAL BLVD
HOUMA, LA 70363
Medicare Provider Number
190183
Participating Start Date
1/1/1998
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
OCHSNER PHARMACY AND WELLNESS- ST. ANNE
Pharmacy Address
108 ACADIA PARK DR
RACELAND, LA 70394
Pharmacy Comments
Contract Details
Approval Date
7/19/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Phyllis Peoples, Executive CEO
(985) 873-4664
Contract Pharmacy Representative
Ochsner Pharmacy
Richard Ricky Indovina Jr., Director of Reatail Pharmacy Operations
(504) 842-5623
Signed By Date
7/19/2023
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