Contract Pharmacy Details

WALGREEN LOUISIANA CO., INC.
DSH190005 University Medical Center Management Corporation d/b/a University Medical Center New Orleans

Covered Entity Details

Entity Name

University Medical Center Management Corporation d/b/a University Medical Center New Orleans

Subdivision Name

UMCNO

Type

Disproportionate Share Hospital

340B ID

DSH190005

Entity Address

2000 Canal Street
NEW ORLEANS, LA 70112

Medicare Provider Number

190005

Participating Start Date

1/1/1997

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

WALGREEN LOUISIANA CO., INC.

Pharmacy Address

DBA: WALGREENS #15571
4501 AIRLINE DR.
METAIRIE, LA 70001

Pharmacy Comments

Contract Details

Approval Date

7/5/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Lisa Miranda, Chief Operating Officer
(504) 702-4411

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/5/2017

340B Drug Pricing Program Database