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LOUISIANA CVS PHARMACY, L.L.C.
DSH190202 OCHSNER MEDICAL CENTER- BATON ROUGE, LLC
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Covered Entity Details
Entity Name
OCHSNER MEDICAL CENTER- BATON ROUGE, LLC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190202
Entity Address
17000 MEDICAL CENTER DR.
BATON ROUGE, LA 70816
Medicare Provider Number
190202
Participating Start Date
7/1/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05294
285 WEST PINE
PONCHATOULA, LA 70454
Pharmacy Comments
Contract Details
Approval Date
4/14/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dawn Pevey-Mauk, CHIEF OPERATINGOFFICER
(225) 755-4800
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
4/14/2014
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