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OCHSNER PHARMACY AND WELLNESS LLC
DSH190006 UNIVERSITY HOSPITAL AND CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL AND CLINICS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190006
Entity Address
2390 W CONGRESS ST.
LAFAYETTE, LA 70506
Medicare Provider Number
190006
Participating Start Date
1/1/1998
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
OCHSNER PHARMACY AND WELLNESS LLC
Pharmacy Address
DBA OCHSNER PHARMACY AND WELLNESS - MAIN
1514 JEFFERSON HWY
NEW ORLEANS, LA 70121
Pharmacy Comments
Contract Details
Approval Date
4/6/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Katherine Hebert, Chief Executive Officer
(337) 261-6004
Contract Pharmacy Representative
Ochsner Pharmacy
Richard Ricky Indovina Jr., Director of Reatail Pharmacy Operations
(504) 842-5623
Signed By Date
4/6/2018
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