Contract Pharmacy Details

WALGREEN LOUISIANA CO., INC.
DSH190201 CHRISTUS Lake Area Hospital

Covered Entity Details

Entity Name

CHRISTUS Lake Area Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190201

Entity Address

4200 NELSON RD
LAKE CHARLES, LA 70605

Medicare Provider Number

190201

Participating Start Date

1/1/2018

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

WALGREEN LOUISIANA CO., INC.

Pharmacy Address

DBA: WALGREENS # 06577
2755 COUNTRY CLUB ROAD
LAKE CHARLES, LA 70605

Pharmacy Comments

Contract Details

Approval Date

1/10/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Robbin Odom, CEO
(337) 475-4145

Contract Pharmacy Representative

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

Signed By Date

1/10/2018

340B Drug Pricing Program Database