Contract Pharmacy Details

LOUISIANA CVS PHARMACY, L.L.C.
DSH190020 LANE REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

LANE REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190020

Entity Address

6300 MAIN STREET
ZACHARY, LA 70791

Medicare Provider Number

190020

Participating Start Date

4/1/2008

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

LOUISIANA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY #1924
20501 OLD SCENIC HWY
ZACHARY, LA 70791-7365

Pharmacy Comments

Contract Details

Approval Date

7/1/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/21/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Mark Anderson, Chief Financial Officer
(225) 658-4302

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/1/2016

340B Drug Pricing Program Database