Covered Entity Details

CH06287R EXCELTH, INCORPORATED (Active) - information as of 6/19/2025 11:53:07 PM

Main Details

Name

EXCELTH, INCORPORATED

Subdivision Name

EXCELth, Inc. FHC - BATON ROUGE

Type

HRSA-Funded Health Center

Site ID

BPS-H80-036646

340B ID

CH06287R

Grant Number

H80CS00129

Additional Details

Current Program Status

Active

Registration Date

1/14/2025

Participating Start Date

4/1/2025

Participating Approval Date

1/27/2025

Last Recertification Date

Contacts

Authorizing Official

EXCELth, Inc.
MICHAEL A. ANDRY, CEO
(504) 524-1210 Ext: 4123

Primary Contact

EXCELth, Inc.
Andy Belteau, Accountant
(504) 524-1210 Ext: 4122

Addresses

Street Address

730 Colonial Dr. STE E
BATON ROUGE, LA 70806

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH062870	Active	BPS-H80-003793	EXCELTH, INCORPORATED	EXCELTH, INC., HEALTH CARE NETWORK	1515 Poydras St		New Orleans	LA
CH06287A	Active	BPS-H80-010581	EXCELTH, INCORPORATED	EXCELth Family Health Center - Algiers	4422 General Meyer Ave 103		New Orleans	LA
CH06287K	Active	BPS-H80-038785	EXCELTH, INCORPORATED	EXCELth Family Health Center - Gentilly	6600 FRANKLIN AV	Suite A7	New Orleans	LA
CH06287L	Terminated	BPS-H80-006558	EXCELTH, INCORPORATED	EXCELth FAMILY HLTH CTR MOBILE VAN	1515 Poydras St		New Orleans	LA
CH06287M	Active	BPS-H80-012673	EXCELTH, INCORPORATED	EXCELth Family Health Center - New Orleans East	9900 Lake Forest Blvd. STE F		New Orleans	LA
CH06287N	Active	BPS-H80-000481	EXCELTH, INCORPORATED	EXCELth, Inc. Dental Clinic - Algiers	1111 Newton St		New Orleans	LA
CH06287P	Active	BPS-H80-018221	EXCELTH, INCORPORATED	EXCELth Mobile Dental Unit	9900 Lake Forest Blvd		New Orleans	LA
CH06287Q	Terminated	BPS-H80-004171	EXCELTH, INCORPORATED	EXCELth, Inc. FHC - BATON ROUGE	4560 North Blvd STE 104		Baton Rouge	LA
CH06287R	Active	BPS-H80-036646	EXCELTH, INCORPORATED	EXCELth, Inc. FHC - BATON ROUGE	730 Colonial Dr. STE E		BATON ROUGE	LA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH062870	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	10/01/2013
CH06287N	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	07/01/2014
CH062870	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	07/01/2016	09/01/2024
CH06287N	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	07/01/2016
CH062870	AVITA PHARMACY 1039	1631 ELYSIAN FIELDS AVE STE 200		NEW ORLEANS	LA	70117-8208	01/01/2025
CH062870	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/01/2013
CH062870	GENERAL MEYER PHARMACY	3510 GENERAL MEYER AVE	SUITE B	NEW ORLEANS	LA	70114	10/01/2022
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05324	3384 GOVERNMENT ST	BATON ROUGE	LA	70806	01/01/2020	09/18/2023
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10538	5000 NORTH CLAIBORNE AVE.	NEW ORLEANS	LA	70117	01/01/2020
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10483	1600 ELYSIAN FIELDS AVE.	NEW ORLEANS	LA	70117	01/01/2020
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 167	4401 S CLAIBORNE AVE.	NEW ORLEANS	LA	70125	01/01/2020
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05615	2520 PLANK RD	BATON ROUGE	LA	70805	01/01/2020
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10058	1116 LOUISIANA AVE	NEW ORLEANS	LA	70115	01/01/2020
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10594	500 N. CARROLLTON AVE.	NEW ORLEANS	LA	70119	01/01/2020
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 8266	2585 LEON C, SIMON DR.	NEW ORLEANS	LA	70122	01/01/2020
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10108	5902 READ BLVD.	NEW ORLEANS	LA	70127	01/01/2020
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05387	3621 GENERAL DEGAULLE DR.	NEW ORLEANS	LA	70131	01/01/2020
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00763	800 - B CANAL ST	NEW ORLEANS	LA	70112	07/01/2022
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01116	7777 BLUEBONNET BLVD,, SUITE 100	BATON ROUGE	LA	70810	07/01/2022
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY #03730	3700 S. CARROLLTON AVE.	NEW ORLEANS	LA	70118	07/01/2022
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04752	1203 WESTBANK EXPRESSWAY	WESTWEGO	LA	70094	07/01/2022
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05333	2242 WILLIAMS BLVD.,	KENNER	LA	70062	07/01/2022
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05342	3535 SEVERN AVE	METAIRIE	LA	70002	07/01/2022
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05383	4950 W ESPLANADE AVE	METAIRIE	LA	70006	07/01/2022
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 5409	1950 BARATARIA BLVD.	MARRERO	LA	70072	07/01/2022
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10220	101 DAVID DR.	METAIRIE	LA	70003	07/01/2022	05/22/2023
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10559	939 GIROD ST., SUITE 160	NEW ORLEANS	LA	70113	07/01/2022
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16783	1731 MANHATTAN BLVD	HARVEY	LA	70058	07/01/2022
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05441	4301 AIRLINE DRIVE	METAIRIE	LA	70001	10/01/2024
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	CVS/PHARMACY #11427	2564 BARATARIA BLVD	MARRERO	LA	70072	10/01/2024
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05319	5889 AIRLINE HWY	BATON ROUGE	LA	70805	01/01/2025	04/04/2025
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05322	9608 JEFFERSON HWY	BATON ROUGE	LA	70809	01/01/2025
CH062870	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY #06124	7411 FLORIDA BLVD.	BATON ROUGE	LA	70806	01/01/2025
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02995	3550 GOVERNMENT ST	BATON ROUGE	LA	70806	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02982	5450 PLANK ROAD	BATON ROUGE	LA	70805	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09860	5955 AIRLINE HWY	BATON ROUGE	LA	70805-3202	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03889	4110 GENERAL DEGAULLE DR	NEW ORLEANS	LA	70131	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07836	3671 JOOR ROAD	BATON ROUGE	LA	70814-3104	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 11498	5061 MAIN STREET	ZACHARY	LA	70791	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15200	2001 CAROL SUE AVE	GRETNA	LA	70056-4445	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05040	1801 SAINT CHARLES AVE	NEW ORLEANS	LA	70130	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04451	4400 S.CLAIBORNE AVE.	NEW ORLEANS	LA	70125	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03610	12881 PERKINS RD.	BATON ROUGE	LA	70810	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02980	4747 S SHERWOOD FOREST	BATON ROUGE	LA	70816	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11414	3216 GENTILLY BLVD	NEW ORLEANS	LA	70122	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06506	89 WESTBANK EXPRESSWAY	GRETNA	LA	70053-3662	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02996	11297 FLORIDA BLVD	BATON ROUGE	LA	70815	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06028	9820 OLD HAMMOND HWY	BATON ROUGE	LA	70816	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05358	11297 LAKE FOREST BLVD.	NEW ORLEANS	LA	70128	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #16312	5702 CROWDER BLVD	NEW ORLEANS	LA	70127	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02262	1100 ELYSIAN FIELDS	NEW ORLEANS	LA	70117	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03139	1826 N BROAD ST	NEW ORLEANS	LA	70119	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07415	100 W JUDGE PEREZ DRIVE	CHALMETTE	LA	70043-5002	11/04/2011
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #12557	4550 GENERAL MEYER AVE	NEW ORLEANS	LA	70131	10/04/2012
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03024	4200 CHEF MENTEUR HWY	NEW ORLEANS	LA	70126	10/01/2017	01/22/2025
CH06287N	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03889	4110 GENERAL DEGAULLE DR	NEW ORLEANS	LA	70131	07/01/2014
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #04982	7401 READ BLVD	NEW ORLEANS	LA	70127	04/01/2018	01/29/2025
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03558	6201 ELYSIAN FIELDS AVE	NEW ORLEANS	LA	70122	01/01/2020
CH062870	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #15198	1111 MEDICAL CENTER BLVD STE 116N	MARRERO	LA	70072	01/01/2020
CH062870	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16395	2000 CANAL ST STE G1-1200	NEW ORLEANS	LA	70112	01/01/2020
CH062870	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	04/01/2025
CH062870	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2025
CH062870	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2025
CH062870	WINN DIXIE PHARMACY # 1439	9701 CHEF MENTEUR HWY		NEW ORLEANS	LA	70127	01/01/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		ANDRY, MICHAEL A. CEO EXCELth, Inc. 5045241210-4123	1/27/2025 2:31 PM
Details	340B ID	Update	New Registration		CH06287R	1/27/2025 2:31 PM
Dates	Participating Approval Date	Update	New Registration		1/27/2025 2:31:14 PM	1/27/2025 2:31 PM
Details	State	Update	New Registration	Pending	Approved	1/27/2025 2:31 PM
Dates	Signed By Date	Update	New Registration		1/14/2025 2:17:53 PM	1/27/2025 2:31 PM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	1/27/2025 2:31 PM
Addresses	Main Address	Insert	New Registration		730 Colonial Dr. STE E BATON ROUGE, LA 70806	1/14/2025 2:17 PM
Contacts	Authorizing Official	Insert	New Registration		ANDRY, MICHAEL A. CEO EXCELth, Inc. 5045241210-4123	1/14/2025 2:17 PM
Contacts	Primary Contact	Insert	New Registration		Belteau, Andy Accountant EXCELth, Inc. 5045241210-4122	1/14/2025 2:17 PM
Details	Assistance Received From Date	Insert	New Registration			1/14/2025 2:17 PM
Details	Assistance Received To Date	Insert	New Registration			1/14/2025 2:17 PM
Details	Last Recertification Date	Insert	New Registration			1/14/2025 2:17 PM
Details	Grant Number	Insert	New Registration		H80CS00129	1/14/2025 2:17 PM
Details	340B ID	Insert	New Registration			1/14/2025 2:17 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/14/2025 2:17 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/14/2025 2:17 PM
Details	Medicare Provider Number	Insert	New Registration			1/14/2025 2:17 PM
Details	Entity Name	Insert	New Registration		EXCELTH, INCORPORATED	1/14/2025 2:17 PM
Details	NOFO Number	Insert	New Registration			1/14/2025 2:17 PM
Details	Program Code	Insert	New Registration		CH	1/14/2025 2:17 PM
Details	Entity Subname	Insert	New Registration		EXCELth, Inc. FHC - BATON ROUGE	1/14/2025 2:17 PM
Dates	Participating Approval Date	Insert	New Registration			1/14/2025 2:17 PM
Details	State	Insert	New Registration		Pending	1/14/2025 2:17 PM
Dates	Registration Date	Insert	New Registration		1/14/2025 2:17:51 PM	1/14/2025 2:17 PM
Dates	Signed By Date	Insert	New Registration			1/14/2025 2:17 PM
Dates	Start Date	Insert	New Registration			1/14/2025 2:17 PM
Terminations	Termination Comments	Insert	New Registration			1/14/2025 2:17 PM
Terminations	Termination Date	Insert	New Registration			1/14/2025 2:17 PM
Terminations	Termination Effective Date	Insert	New Registration			1/14/2025 2:17 PM
Terminations	Termination Reason	Insert	New Registration			1/14/2025 2:17 PM

340B Drug Pricing Program Database