Contract Pharmacy Details

J & K DRUGS
DSH190184 CITIZENS MEDICAL CENTER

Covered Entity Details

Entity Name

CITIZENS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190184

Entity Address

7939 HWY 165
COLUMBIA, LA 71418

Medicare Provider Number

190184

Participating Start Date

1/1/2024

Last Recertification Date

8/28/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

J & K DRUGS

Pharmacy Address

7190 HIGHWAY 165
COLUMBIA, LA 71418-3302

Pharmacy Comments

Contract Details

Approval Date

11/7/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Steven Lynn Barbo, CEO
(318) 649-6106

Contract Pharmacy Representative

Book's Pharmacy LTD
George T. Book, Owner
(318) 414-2616

Signed By Date

10/16/2023