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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 # 01116
7777 BLUEBONNET BLVD,, SUITE 100
BATON ROUGE, LA 70810
Pharmacy Comments
Contract Details
Approval Date
7/16/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dawn Pevey-Mauk, CHIEF OPERATINGOFFICER
(225) 755-4800
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/16/2016
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