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THE MEDICINE CABINET
DSH190184 CITIZENS MEDICAL CENTER
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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
THE MEDICINE CABINET
Pharmacy Address
7623 HIGHWAY 165
COLUMBIA, LA 71418
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
MEDICINE CABINET PHARMACY
DANIELLE O'DONNELL, CO-OWNER/PIC
(318) 649-6410
Signed By Date
10/16/2023
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