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ACCREDO HEALTH GROUP, INC.
DSH190312 OUR LADY OF THE ANGELS HOSPITAL
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Covered Entity Details
Entity Name
OUR LADY OF THE ANGELS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190312
Entity Address
433 Plaza Street
BOGALUSA, LA 70427
Medicare Provider Number
190312
Participating Start Date
4/1/2015
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
Pharmacy Comments
Contract Details
Approval Date
10/31/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brooke Cummings, VP Finance
(985) 730-7040
Contract Pharmacy Representative
Accredo Health Group
Gene McCabe, 340B Sales Director
(615) 943-7500
Signed By Date
10/31/2016
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