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FRED'S XPRESS #3861
CH062480 CATAHOULA PARISH HOSPITAL DISTRICT # 2
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Covered Entity Details
Entity Name
CATAHOULA PARISH HOSPITAL DISTRICT # 2
Subdivision Name
ISLAND MEDICAL & DENTAL
Type
HRSA-Funded Health Center
340B ID
CH062480
Entity Address
307 Chisum St
Sicily Island, LA 71368
Grant Number
H80CS00206
Participating Start Date
1/1/1999
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
FRED'S XPRESS #3861
Pharmacy Address
705 PLANK ROAD
PO BOX 5
ST JOSEPH, LA 71366
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Debra K. Miesch, CEO
(318) 389-5727 Ext: 1407
Contract Pharmacy Representative
Fred's Pharmacy
Betty Ngo, Sr. Director 340B Program Operations
(901) 481-0346
Signed By Date
10/13/2016
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