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WALGREEN LOUISIANA CO., INC.
DSH190011 BRFHH Monroe LLC d/b/a Ochsner LSU Health Monroe
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Covered Entity Details
Entity Name
BRFHH Monroe LLC d/b/a Ochsner LSU Health Monroe
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190011
Entity Address
4864 JACKSON STREET
MONROE, LA 71202
Medicare Provider Number
190011
Participating Start Date
1/1/1998
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS # 10510
5349 CYPRESS ST
WEST MONROE, LA 71291-7505
Pharmacy Comments
Contract Details
Approval Date
10/7/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Larry Donner, CEO
(318) 330-7525
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/7/2014
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