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WALGREEN LOUISIANA CO., INC.
DSH190201 CHRISTUS Lake Area Hospital
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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 #10508
4097 RYAN ST
LAKE CHARLES, LA 70605-2819
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
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