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WALGREEN LOUISIANA CO., INC.
DSH190176 University Healthcare System.L.C. d/b/a East Jefferson General Hospital
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Covered Entity Details
Entity Name
University Healthcare System.L.C. d/b/a East Jefferson General Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190176
Entity Address
4200 Houma Blvd.
Metairie, LA 70006
Medicare Provider Number
190176
Participating Start Date
4/1/2023
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS # 04305
900 CANAL
NEW ORLEANS, LA 70112
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bradley Scott Sinclair, CFO
(504) 962-6048
Contract Pharmacy Representative
University Healthcare System LLC
Anthony Irvin Laurent, Pharmacy Director
(504) 503-6255
Signed By Date
1/16/2024
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