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WELLPARTNER, INC
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
WELLPARTNER, INC
Pharmacy Address
20800 SW 115TH AVE
SUITE 100
TUALATIN, OR 97062
Pharmacy Comments
Contract Details
Approval Date
4/4/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/4/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jim Juneau, CFO
(337) 948-5133
Contract Pharmacy Representative
Wellpartner, inc
Harish Thiagaraj, Senior Vice President of Pharmacy/Specialty Pharmacy
(503) 906-6887
Signed By Date
4/4/2017
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