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LOUISIANA CVS PHARMACY, L.L.C.
CAH191313-00 RIVERSIDE MEDICAL CENTER
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Covered Entity Details
Entity Name
RIVERSIDE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191313-00
Entity Address
1900 MAIN STREET
FRANKLINTON, LA 70438-3688
Medicare Provider Number
191313
Participating Start Date
9/21/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05277
329 SUPERIOR AVE.
BOGALUSA, LA 70427
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Benjamin Lott, Assistant Administrator/VP Clinical Services
(985) 795-4150
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
1/14/2014
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