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LOUISIANA CVS PHARMACY, L.L.C.
PED193300-00 Children's Hospital
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Covered Entity Details
Entity Name
Children's Hospital
Subdivision Name
Type
Children's Hospital
340B ID
PED193300-00
Entity Address
200 HENRY CLAY AVENUE
NEW ORLEANS, LA 70118
Medicare Provider Number
193300
Participating Start Date
1/1/2014
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
CVS/PHARMACY #11426
888 TERRY PKWY
TERRYTOWN, LA 70056-5270
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lucio A. Fragoso, President & CEO
(504) 896-9452
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2025
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