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COMMCARE PHARMACY-FTL, LLC
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
COMMCARE PHARMACY-FTL, LLC
Pharmacy Address
855 SW 78TH AVE STE C100
PLANTATION, FL 33324-3223
Pharmacy Comments
Contract Details
Approval Date
1/18/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dawn Pevey-Mauk, CHIEF OPERATINGOFFICER
(225) 755-4800
Contract Pharmacy Representative
Commcare Pharmacy
Avani Patel, Client Relations Manager
(954) 284-2358
Signed By Date
1/18/2017
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