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FRED'S PHARMACY #1684
DSH190017 OPELOUSAS GENERAL HOSPITAL
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Covered Entity Details
Entity Name
OPELOUSAS GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190017
Entity Address
539 EAST PRUDHOMME ST
OPELOUSAS, LA 70570
Medicare Provider Number
190017
Participating Start Date
4/1/2003
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
FRED'S PHARMACY #1684
Pharmacy Address
821 SOUTH MAIN STREET
CHURCH POINT, LA 70525
Pharmacy Comments
Contract Details
Approval Date
4/1/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/2/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Jim Juneau, CFO
(337) 948-5133
Contract Pharmacy Representative
Shannon Strickland, SVP, Pharmacy Development
(901) 238-3113
Signed By Date
4/1/2015
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