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WALGREEN LOUISIANA CO., INC.
DSH190034 ABBEVILLE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
ABBEVILLE GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190034
Entity Address
118 NORTH HOSPITAL DRIVE
ABBEVILLE, LA 70510
Medicare Provider Number
190034
Participating Start Date
9/15/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS #13134
6130 JOHNSTON ST.
LAFAYETTE, LA 70503
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RAY LANDRY, CEO
(337) 898-6500
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2017
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