Contract Pharmacy Details

WALGREEN LOUISIANA CO., INC.
DSH190044 ACADIA GENERAL HOSPITAL

Covered Entity Details

Entity Name

ACADIA GENERAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190044

Entity Address

1305 CROWLEY RAYNE HWY.
CROWLEY, LA 70526

Medicare Provider Number

190044

Participating Start Date

4/1/2011

Last Recertification Date

8/27/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

WALGREEN LOUISIANA CO., INC.

Pharmacy Address

DBA: WALGREENS #10577
1804 ELTON RD
JENNINGS, LA 70546-3002

Pharmacy Comments

Contract Details

Approval Date

1/7/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

CHARMAINE R. VIDRINE, CFO
(337) 788-6402

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/7/2016

340B Drug Pricing Program Database