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LOUISIANA CVS PHARMACY, L.L.C.
CAH191325-00 LAFOURCHE HOSPITAL SERVICE DISTRICT #1 DBA LADY OF THE SEA GENERAL HOSPITAL
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Covered Entity Details
Entity Name
LAFOURCHE HOSPITAL SERVICE DISTRICT #1 DBA LADY OF THE SEA GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191325-00
Entity Address
200 WEST 134TH PLACE
CUT OFF, LA 70345
Medicare Provider Number
191325
Participating Start Date
9/14/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05432
16804 W. MAIN ST
CUT OFF, LA 70345
Pharmacy Comments
Contract Details
Approval Date
10/7/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/24/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Karen S. Collins, C.E.O.
(985) 632-8286
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
10/7/2013
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