Contract Pharmacy Details

LOUISIANA CVS PHARMACY, L.L.C.
DSH190202 OCHSNER MEDICAL CENTER- BATON ROUGE, LLC

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

CVS PHARMACY # 16708
6885 SIEGEN LN
BATON ROUGE, LA 70809

Pharmacy Comments

Contract Details

Approval Date

10/14/2016

Contract Begin Date

1/1/2017

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

10/14/2016

340B Drug Pricing Program Database