Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH190017 OPELOUSAS GENERAL HOSPITAL

Covered Entity Details

Entity Name

OPELOUSAS GENERAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190017

Entity Address

539 EAST PRUDHOMME ST
OPELOUSAS, LA 70570

Medicare Provider Number

190017

Participating Start Date

4/1/2003

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY #2751
426 S. HENDERSON STREET
FORT WORTH, TX 76104

Pharmacy Comments

Contract Details

Approval Date

4/9/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jim Juneau, CFO
(337) 948-5133

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/9/2018

340B Drug Pricing Program Database