Covered Entity Details

CH061335AA ST. CHARLES COMMUNITY HEALTH CENTER, INC. (Active) - information as of 4/24/2025 10:11:25 PM

Main Details

Name

ST. CHARLES COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Access Health Louisiana Kenner

Type

HRSA-Funded Health Center

Site ID

BPS-H80-015334

340B ID

CH061335AA

Grant Number

H80CS00867

Additional Details

Current Program Status

Active

Registration Date

4/5/2016

Participating Start Date

7/1/2016

Participating Approval Date

4/11/2016

Last Recertification Date

2/26/2025

Contacts

Authorizing Official

Access Health Louisiana
MARK F. KEISER, CEO
(504) 575-3746

Primary Contact

Access Health Louisiana
Shikenya Johnson, 340B Program Coordinator
(504) 575-3743

Addresses

Street Address

2900 Indiana Avenue
Kenner, LA 70065-4605

Billing Address

Access Health Louisiana
843 Milling Avenue
Luling, LA 70070

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?
Yes

State	Medicaid Number	NPI Number
LA	2205447	1174035299,1467108100

Shipping Addresses

Shipping Address 1

Access Health Louisiana Pharmacy
843 Milling Avenue
Suite 110
Luling, LA 70070

Shipping Address 2

Access Health Louisiana Pharmacy-Kenner
671 W. Esplanade Avenue
Suite 120
Kenner, LA 70065

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	City	State
CH061335A	Active	BPS-H80-004076	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	ST. CHARLES COMMUNITY HEALTH CENTER	843 Milling Ave	Luling	LA
CH061335AA	Active	BPS-H80-015334	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Access Health Louisiana Kenner	2900 Indiana Avenue	Kenner	LA
CH061335AB	Terminated	BPS-H80-018565	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Access Health Louisiana Primary Care	1415 Tulane Avenue, 5th Floor Ste 5501	New Orleans	LA
CH061335AC	Active	BPS-H80-017809	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Plaquemine High School SBHC	59595 Belleview Rd	Plaquemine	LA
CH061335AD	Active	BPS-H80-021963	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Access Health Louisiana Primary Care at the Pythian	234 Loyola Avenue, Fl 3	New Orleans	LA
CH061335AE	Active	BPS-H80-025004	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Iberville Elementary School SBHC	58650 Iron Farm Rd	Plaquemine	LA
CH061335AF	Active	BPS-H80-024550	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	MSA-West Academy	57955 Saint Louis Rd	Plaquemine	LA
CH061335AG	Active	BPS-H80-024525	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Oakdale School-Based Health Center	124 S 13th St Bldg 2	Oakdale	LA
CH061335AH	Active	BPS-H80-027688	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Bogalusa High School-Based Health Center	100 M J Israel Dr	Bogalusa	LA
CH061335AJ	Active	BPS-H80-029826	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Access Health Louisiana Lutcher High School SBHC	1910 W Main St	Lutcher	LA
CH061335AK	Active	BPS-H80-028281	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Acadian Care Slidell	113 Christian Lane	Slidell	LA
CH061335AL	Terminated	BPS-H80-028293	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Acadian Care New Orleans	1500 Baronne Street	New Orleans	LA
CH061335AM	Terminated	BPS-H80-028283	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Acadian Care Hammond	2545 Veterans Ave	Hammond	LA
CH061335AN	Active	BPS-H80-028282	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	St. Tammany Mandeville CHC	1150 W Causeway Approach	Mandeville	LA
CH061335AP	Terminated	BPS-H80-030169	Access Health Louisiana	Westbank Community School SBHC	2590 Barataria Blvd	Marrero	LA
CH061335AQ	Active	BPS-H80-030173	Access Health Louisiana	East Jefferson High School SBHC	400 Phlox Ave	Metairie	LA
CH061335AR	Active	BPS-H80-030170	Access Health Louisiana	Catherine Strehle Elementary School SBHC	178 Millie Dr	Avondale	LA
CH061335AS	Active	BPS-H80-030172	Access Health Louisiana	Haynes Academy SBHC	4301 Grace King Pl	Metairie	LA
CH061335AT	Active	BPS-H80-030171	Access Health Louisiana	Chateau Estates Elementary School SBHC	4121 Medoc Dr	Kenner	LA
CH061335AU	Terminated	BPS-H80-032500	Access Health Louisiana	Kenner Community Health Center	819 W Esplanade Ave	Kenner	LA
CH061335AV	Active	BPS-H80-031260	Access Health Louisiana	Douglass Community School SBHC	1400 Huey P Long Ave	Gretna	LA
CH061335AW	Active	BPS-H80-032863	Access Health Louisiana	St. James Alternative School	3125 Valcour Aime St	Vacherie	LA
CH061335AX	Active	BPS-H80-033570	ACCESS HEALTH LOUISIANA	Destrehan High SBHC	1 Wildcat Ln	Destrehan	LA
CH061335AY	Active	BPS-H80-033930	ACCESS HEALTH LOUISIANA	Hahnville High SBHC	200 Tiger Dr	Boutte	LA
CH061335AZ	Active	BPS-H80-032500	ACCESS HEALTH LOUISIANA	Kenner Community Health Center 671	671 W. Esplanade Avenue	Kenner	LA
CH061335B	Terminated	BPS-H80-017722	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Kenner Community Health Center	1401 W. Esplanade Ave.	Kenner	LA
CH061335BA	Active	BPS-H80-034495	ACCESS HEALTH LOUISIANA	Luling Elementary School SBHC	904 Sugarhouse Rd	Luling	LA
CH061335BB	Active	BPS-H80-036459	ACCESS HEALTH LOUISIANA	Tioga High SBHC	1207 Tioga Rd	Ball	LA
CH061335BC	Active	BPS-H80-036279	ACCESS HEALTH LOUISIANA	Pollock Elementary SBHC	4001 Highway 8	Pollock	LA
CH061335BD	Active	BPS-H80-033544	ACCESS HEALTH LOUISIANA	Woodworth Community Health Center	9374 Highway 165 S	Woodworth	LA
CH061335BE	Active	BPS-H80-036278	ACCESS HEALTH LOUISIANA	Pineville Jr High SBHC	501 Edgewood Dr	Pineville	LA
CH061335BF	Active	BPS-H80-036305	ACCESS HEALTH LOUISIANA	Jena Jr High SBHC	610 E. Southern Avenue	Jena	LA
CH061335BG	Active	BPS-H80-036458	ACCESS HEALTH LOUISIANA	Provencal Elementary SBHC	132 Cherry Street	Provencal	LA
CH061335BH	Active	BPS-H80-036457	ACCESS HEALTH LOUISIANA	Tioga Jr High SBHC	1150 Tioga Rd	Ball	LA
CH061335BJ	Active	BPS-H80-036286	ACCESS HEALTH LOUISIANA	Marthaville Elementary SBHC	10800 Highway 120	Marthaville	LA
CH061335BK	Active	BPS-H80-036477	ACCESS HEALTH LOUISIANA	Glenmora High SBHC	1518 7th Avenue	Glenmora	LA
CH061335BL	Active	BPS-H80-036287	ACCESS HEALTH LOUISIANA	Lakeview High SBHC	7305 Hwy 9	Campti	LA
CH061335BM	Active	BPS-H80-036456	ACCESS HEALTH LOUISIANA	Buckeye High SBHC	715 Highway 1207	Deville	LA
CH061335BN	Active	BPS-H80-035720	ACCESS HEALTH LOUISIANA	Harry S. Truman School SBHC	5417 Ehret Road	Marrero	LA
CH061335BP	Active	BPS-H80-036277	ACCESS HEALTH LOUISIANA	Lessie Moore Elementary SBHC	207 Griffith St	Pineville	LA
CH061335BQ	Active	BPS-H80-036285	ACCESS HEALTH LOUISIANA	Natchitoches Central High SBHC	6513 Highway 1 South Bypass	Natchitoches	LA
CH061335BR	Active	BPS-H80-036462	ACCESS HEALTH LOUISIANA	Grant Jr and High SBHC	17763 Highway 167	Dry Prong	LA
CH061335BS	Active	BPS-H80-036460	ACCESS HEALTH LOUISIANA	Northwood SBHC	8830 Highway 1 N.	Lena	LA
CH061335BT	Active	BPS-H80-036306	ACCESS HEALTH LOUISIANA	Jena High SBHC	243 E High School Dr	Jena	LA
CH061335BU	Active	BPS-H80-036461	ACCESS HEALTH LOUISIANA	Avoyelles High SBHC	287 Main St	Moreauville	LA
CH061335BV	Active	BPS-H80-036463	ACCESS HEALTH LOUISIANA	Avoyelles Public Charter SBHC	201 Longfellow Rd	Mansura	LA
CH061335C	Active	BPS-H80-009509	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Albert CammonWellness Center AKA St Rose School Based Health Center	232 Pirate Dr	Saint Rose	LA
CH061335D	Active	BPS-H80-012385	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	ST Bernard Community Health Center	8050 W Judge Perez Dr	Chalmette	LA
CH061335E	Active	BPS-H80-010854	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	St Tammany Community Health Center - Slidell	501 Robert Blvd	Slidell	LA
CH061335G	Active	BPS-H80-010852	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Bonnabel High School SBHC Mental Health Services	2801 Bruin Dr.	Kenner	LA
CH061335H	Active	BPS-H80-011493	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Belle Chasse Community Health Center	8200 Highway 23	Belle Chasse	LA
CH061335J	Active	BPS-H80-011959	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	St Charles Community Health Center - Norco	16004 River Rd	Norco	LA
CH061335K	Terminated	BPS-H80-012176	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Ruth U. Fertel/Tulane Community Health Center	711 N Broad St	New Orleans	LA
CH061335L	Terminated	BPS-H80-012384	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	St. Tammany Community Health Center Covington	1301 N. Florida St	Covington	LA
CH061335M	Terminated	BPS-H80-010278	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	St Charles CHC - 1057 Paul Maillard	1057 Paul Maillard Road 240	Luling	LA
CH061335N	Active	BPS-H80-012439	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Joshua Butler School Based Health Center	300 Fourth St	Westwego	LA
CH061335P	Active	BPS-H80-012438	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	John Ehret School Based Health Center	4300 Patriot St	Marrero	LA
CH061335Q	Active	BPS-H80-012437	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	West Jefferson School Based Health Center	2200 8th St	Harvey	LA
CH061335R	Active	BPS-H80-012436	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Riverdale School Based Health Center	240 Riverdale Dr	New Orleans	LA
CH061335S	Active	BPS-H80-013542	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Washington Community Health Center	2807 S COLUMBIA ST	BOGALUSA	LA
CH061335T	Active	BPS-H80-014315	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Warren Easton High School SBHC	3036 IBERVILLE ST	NEW ORLEANS	LA
CH061335U	Active	BPS-H80-008079	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	St. Charles Community Health Mobile Unit	843 Milling Avenue	Luling	LA
CH061335V	Active	BPS-H80-014006	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	AHL SBHC Paradis La.	434 South St	Paradis	LA
CH061335W	Active	BPS-H80-014313	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	South Broad Community Health	3300 S BROAD ST	NEW ORLEANS	LA
CH061335X	Terminated	BPS-H80-015081	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Cohen College Prep High School SBHC	3520 DRYADES ST	NEW ORLEANS	LA
CH061335Y	Active	BPS-H80-014971	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Tangipahoa Community Health Center	42351 PHYLLIS ANN DR	HAMMOND	LA
CH061335Z	Active	BPS-H80-017454	ST. CHARLES COMMUNITY HEALTH CENTER, INC.	Woodworth Community Health Center	9372 Highway 165 S.	Woodworth	LA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH061335A	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	01/01/2017	11/14/2022
CH061335A	ACARIAHEALTH PHARMACY, INC.	1736 GAUSE BLVD E STE 24		SLIDELL	LA	70461-5521	01/01/2017	11/14/2022
CH061335A	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2024
CH061335A	ALBERTSONS LLC	SAV-ON PHARMACY #3215	2265 S. MACARTHUR DRIVE	ALEXANDRIA	LA	71301	01/01/2017
CH061335A	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	10/01/2016
CH061335A	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	10/01/2016
CH061335A	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	01/01/2016	05/01/2018
CH061335A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	01/01/2025
CH061335A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	01/01/2025
CH061335A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	01/01/2025
CH061335A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	01/01/2025
CH061335A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	01/01/2025
CH061335A	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2024
CH061335A	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2024
CH061335A	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2024
CH061335A	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2024
CH061335A	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2024
CH061335A	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2024
CH061335A	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2024
CH061335A	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2024
CH061335A	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2024
CH061335A	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2024
CH061335A	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2022
CH061335A	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2022
CH061335A	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2024
CH061335A	DESTREHAN PHARMACY INC.	12627 AIRLINE HWY		DESTREHAN	LA	70047	01/01/2015	01/17/2019
CH061335A	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	01/01/2025
CH061335A	ENCORE PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	05/04/2022
CH061335A	FINNAN'S FAMILY PHARMACY	3044 GAUSE BLVD E		SLIDELL	LA	70461-4155	07/01/2016	01/01/2022
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05544	100 EDGEWOOD DR.	PINEVILLE	LA	71360	10/01/2019
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05288	1500 W AIRLINE HWY	LA PLACE	LA	70068	10/01/2019
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05607	4443 JACKSON ST	ALEXANDRIA	LA	71303	10/01/2019
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05277	329 SUPERIOR AVE.	BOGALUSA	LA	70427	10/01/2019
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05330	1305 GAUSE BLVD.	SLIDELL	LA	70458	10/01/2019
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05528	1313 PAUL MAILLARD RD/PO BOX 50	LULING	LA	70070	10/01/2019	11/19/2021
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2597	2600 PARIS RD	CHALMETTE	LA	70043	10/01/2019
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08921	2831 BELLE CHASE HWY.	TERRYTOWN	LA	70056	10/01/2019
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05442	12589 AIRLINE HWY	DESTREHAN	LA	70047	10/01/2019
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10538	5000 NORTH CLAIBORNE AVE.	NEW ORLEANS	LA	70117	10/01/2019	01/10/2020
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10538	5000 NORTH CLAIBORNE AVE.	NEW ORLEANS	LA	70117	04/01/2020	06/12/2020
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05276	721 BOLTON AVE	ALEXANDRIA	LA	71301	10/01/2021	05/22/2024
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05435	2915 HWY 190	MANDEVILLE	LA	70471	07/01/2022
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08922	1850 N. HIGHWAY 190	COVINGTON	LA	70433	07/01/2022
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	CVS/PHARMACY #11426	888 TERRY PKWY	TERRYTOWN	LA	70056-5270	07/01/2022
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05473	2103 GAUSE BLVD E	SLIDELL	LA	70461	07/01/2022
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05451	1116 WASHINGTON ST	FRANKLINTON	LA	70438	07/01/2022
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10483	1600 ELYSIAN FIELDS AVE.	NEW ORLEANS	LA	70117	07/01/2022
CH061335A	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05543	2850 HIGHWAY 90 WEST	AVONDALE	LA	70094	10/01/2022
CH061335A	MUMFREY'S PHARMACY	1021 WEST JUDGE PEREZ DR		CHALMETTE	LA	70043	01/01/2022	04/15/2025
CH061335A	NIELSEN'S PHARMACY	1619 S COLUMBIA ST		BOGALUSA	LA	70427-5824	01/01/2017	08/23/2018
CH061335A	NIELSENS CITY DRUG STORE	330 AUSTIN ST		BOGALUSA	LA	70427	01/01/2017	08/29/2018
CH061335A	OPTUM PHARMACY 800, INC.	3016 GUADALUPE ST STE A		AUSTIN	TX	78705-2861	10/01/2016
CH061335A	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2024
CH061335A	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2024
CH061335A	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2024
CH061335A	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	01/01/2025
CH061335A	RECEPT PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	07/01/2017	05/02/2022
CH061335AD	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	01/01/2020
CH061335A	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	07/01/2021
CH061335AD	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	01/01/2020
CH061335A	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	07/01/2021
CH061335A	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	01/01/2025
CH061335A	RUSSO'S PHARMACY	7902 HIGHWAY 23		BELLE CHASSE	LA	70037	04/01/2013
CH061335A	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	01/01/2025
CH061335A	SCOTT'S PHARMACY	42242 VETERANS AVE		HAMMOND	LA	70403	01/01/2016	06/27/2016
CH061335A	THRIFT VILLAGE DRUGS	737 PAUL MAILLARD RD SUITE C		LULING	LA	70070	09/28/2017	06/23/2020
CH061335A	THRIFT VILLAGE DRUGS INC	737 PAUL MAILLARD RD	P.O. BOX 26	LULING	LA	70070-0026	11/22/2004	05/01/2018
CH061335A	TOTAL LIFE CARE RX PHARMACY, LLC	TLC RX	2731 MANHATTAN BLVD SUITE B17	HARVEY	LA	70058	01/01/2016	05/01/2018
CH061335A	VAN MOL FAMILY PHARMACY, LLC	9374 HWY 165 S		WOODWORTH	LA	71485	04/01/2016
CH061335A	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2021
CH061335A	WAL-MART PHARMACY 10-0489	2799 W THOMAS STREET		HAMMOND	LA	70401	01/01/2022
CH061335A	WAL-MART PHARMACY 10-0553	39142 NATCHEZ DR		SLIDELL	LA	70461	01/01/2022
CH061335A	WAL-MART PHARMACY 10-0803	401 ONTARIO AVE		BOGALUSA	LA	70427	07/01/2022
CH061335A	WAL-MART PHARMACY 10-0909	8101 W. JUDGE PEREZ DR.		CHALMETTE	LA	70043	07/01/2021
CH061335A	WAL-MART PHARMACY 10-0961	1616 W AIRLINE HWY		LAPLACE	LA	70068	01/01/2022
CH061335A	WAL-MART PHARMACY 10-0989	8912 VETERANS MEMORIAL BLVD		METAIRIE	LA	70003	01/01/2022
CH061335A	WAL-MART PHARMACY 10-1107	1900 HWY 165 SOUTH		OAKDALE	LA	71463	07/01/2021
CH061335A	WAL-MART PHARMACY 10-1163	4001 BEHRMAN HWY		NEW ORLEANS	LA	70114	01/01/2022
CH061335A	WAL-MART PHARMACY 10-1342	300 WEST ESPLANADE		KENNER	LA	70065	07/01/2021
CH061335A	WAL-MART PHARMACY 10-2913	13001 HWY 90		BOUTTE	LA	70039	07/01/2021
CH061335A	WAL-MART PHARMACY 10-3042	2800 N. HIGHWAY 190		COVINGTON	LA	70433	01/01/2022
CH061335A	WAL-MART PHARMACY 10-3703	3520 WILLIAMS BLVD		KENNER	LA	70065	01/01/2022
CH061335A	WAL-MART PHARMACY 10-4295	6225 COLISEUM BLVD		ALEXANDRIA	LA	71303	01/01/2022
CH061335A	WAL-MART PHARMACY 10-5022	1901 TCHOPITOULAS STREET		NEW ORLEANS	LA	70130	01/01/2022
CH061335A	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2021
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15571	4501 AIRLINE DR.	METAIRIE	LA	70001	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06672	909 DAVID DRIVE	METAIRIE	LA	70003-5134	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 01799	1503 METAIRIE RD	METAIRIE	LA	70005	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09861	13500 HWY 90	BOUTTE	LA	70039	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07415	100 W JUDGE PEREZ DRIVE	CHALMETTE	LA	70043-5002	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05472	821 W ESPLANADE	KENNER	LA	70065	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02469	220 W ESPLANADE AVE	KENNER	LA	70065-2460	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05801	1815 W AIRLINE HWY	LAPLACE	LA	70068	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #13586	4141 E JUDGE PEREZ DR	MERAUX	LA	70075	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05358	11297 LAKE FOREST BLVD.	NEW ORLEANS	LA	70128	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04007	1260 FRONT STREET	SLIDELL	LA	70458	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04285	4142 PONTCHARTRAIN DR	SLIDELL	LA	70458-5138	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS #13876	2180 GAUSE BLVD W	SLIDELL	LA	70460	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04290	100 N. MILITARY RD.	SLIDELL	LA	70461	11/02/2012
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02262	1100 ELYSIAN FIELDS	NEW ORLEANS	LA	70117	10/01/2013
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03024	4200 CHEF MENTEUR HWY	NEW ORLEANS	LA	70126	10/01/2013	01/22/2025
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03139	1826 N BROAD ST	NEW ORLEANS	LA	70119	10/01/2013
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04304	145 ELK PLACE	NEW ORLEANS	LA	70112	10/01/2013	11/11/2016
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04305	900 CANAL	NEW ORLEANS	LA	70112	10/01/2013	01/02/2025
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05551	619 DECATUR ST	NEW ORLEANS	LA	70130	10/01/2013	06/08/2022
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10316	4001 CANAL ST	NEW ORLEANS	LA	70119	10/01/2013
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11414	3216 GENTILLY BLVD	NEW ORLEANS	LA	70122	10/01/2013
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #13777	1415 TULANE AVE STE 2CW07	NEW ORLEANS	LA	70112	10/01/2013
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #09997	217 SUPERIOR AVE	BOGALUSA	LA	70427-2622	07/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02468	4545 WEST ESPLANADE	METAIRIE	LA	70006	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02640	3227 MAGAZINE ST	NEW ORLEANS	LA	70115	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03156	1556 LAPALCO BLVD.	HARVEY	LA	70058	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03199	1891 BARATARIA BLVD.	MARRERO	LA	70072	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03432	1511 E TUNNEL BLVD	HOUMA	LA	70363	10/01/2015	01/23/2025
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #16312	5702 CROWDER BLVD	NEW ORLEANS	LA	70127	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03558	6201 ELYSIAN FIELDS AVE	NEW ORLEANS	LA	70122	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03889	4110 GENERAL DEGAULLE DR	NEW ORLEANS	LA	70131	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03990	1203 BUSINESS 190	COVINGTON	LA	70433-3278	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04450	718 S. CARROLLTON AVE.	NEW ORLEANS	LA	70118	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04451	4400 S.CLAIBORNE AVE.	NEW ORLEANS	LA	70125	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #04982	7401 READ BLVD	NEW ORLEANS	LA	70127	10/01/2015	01/29/2025
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05040	1801 SAINT CHARLES AVE	NEW ORLEANS	LA	70130	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05382	4330 HWY 22	MANDEVILLE	LA	70471	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05516	4600 WESTBANK EXPRESSWAY	MARRERO	LA	70072-3065	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #05866	2418 S. CARROLLTON AVE	NEW ORLEANS	LA	70118-3012	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06027	1910 W THOMAS	HAMMOND	LA	70401-2947	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06190	1801 SW RAILROAD AVE	HAMMOND	LA	70403	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06506	89 WESTBANK EXPRESSWAY	GRETNA	LA	70053-3662	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06637	1544 MANHATTAN BLVD	HARVEY	LA	70058	10/01/2015	11/12/2019
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06849	2050 FLORIDA STREET	MANDEVILLE	LA	70448	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07836	3671 JOOR ROAD	BATON ROUGE	LA	70814-3104	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09690	1100 W PINE ST	PONCHATOULA	LA	70454-3700	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #12557	4550 GENERAL MEYER AVE	NEW ORLEANS	LA	70131	10/01/2015	04/19/2017
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #12924	4100 WILLIAMS BLVD	KENNER	LA	70065	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 13658	9705 JEFFERSON HWY	RIVER RIDGE	LA	70123	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #13679	1717 VETERANS MEMORIAL BLVD	METAIRIE	LA	70005-2635	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15067	4607 VETERANS MEMORIAL BLVD.	METAIRIE	LA	70006	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15109	4327 JEFFERSON HWY.	JEFFERSON	LA	70121	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15199	5518 MAGAZINE STREET	NEW ORLEANS	LA	70115-3152	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15200	2001 CAROL SUE AVE	GRETNA	LA	70056-4445	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 15533	7101 VETERANS MEMORIAL BLVD	METAIRIE	LA	70003	10/01/2015
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15570	1504 GAUSE BLVD	SLIDELL	LA	70458	10/01/2015	11/12/2019
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02012	4444 JACKSON STREET	ALEXANDRIA	LA	71303	10/01/2016
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 01657	3333 MASONIC DRIVE	ALEXANDRIA	LA	71301	10/01/2016
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09182	3400 MILITARY HWY	PINEVILLE	LA	71360-4231	01/01/2017
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09526	3100 HIGHWAY 28 E	PINEVILLE	LA	71360	01/01/2017
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #13925	5298 HIGHLAND RD.	BATON ROUGE	LA	70808-6530	10/01/2017
CH061335AC	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #13925	5298 HIGHLAND RD.	BATON ROUGE	LA	70808-6530	07/01/2017
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16478	5555 ESSEN LN STE C	BATON ROUGE	LA	70809	07/01/2019
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #16309	1401 FOUCHER ST STE C-309	NEW ORLEANS	LA	70115	07/01/2019
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15988	1051 GAUSE BLVD STE 101	SLIDELL	LA	70458-2951	07/01/2019	07/31/2019
CH061335AD	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07261	457 LAPALCO BLVD	GRETNA	LA	70056-7366	01/01/2020
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07261	457 LAPALCO BLVD	GRETNA	LA	70056-7366	07/01/2021
CH061335A	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02980	4747 S SHERWOOD FOREST	BATON ROUGE	LA	70816	07/01/2024
CH061335A	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	01/01/2024
CH061335A	WALMART PHARMACY 10-3167	4301 CHEF MENTEUR HWY		NEW ORLEANS	LA	70126	07/01/2022
CH061335A	WALMART PHARMACY 10-3727	812 BELLEAU WOOD BLVD		ALEXANDRIA	LA	71303	01/01/2022
CH061335A	WALMART PHARMACY 10-3736	2750 HIGHWAY 28 E		PINEVILLE	LA	71360	01/01/2022
CH061335A	WALMART PHARMACY 10-4129	1331 HIGHWAY 51		PONCHATOULA	LA	70454	07/01/2022
CH061335A	WALMART PHARMACY 10-5081	2500 ARCHBISHOP HANNAN BLVD		MERAUX	LA	70075	07/01/2021
CH061335A	WALMART PHARMACY 10-6577	637 ROBERT BLVD		SLIDELL	LA	70458	01/01/2022
CH061335A	WALMART PHARMACY 10-6588	3130 PONTCHARTRAIN DRIVE		SLIDELL	LA	70458	01/01/2022
CH061335A	WILKINSON FAMILY PHARMACY	LLC	3001 PARIS ROAD	CHALMETTE	LA	70043	01/01/2014	05/01/2018
CH061335A	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1444	12125 HWY 90	LULING	LA	70070	07/01/2016	10/29/2023
CH061335A	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1588	12519 AIRLINE HWY, SUITE A	DESTREHAN	LA	70047	07/01/2016	11/19/2023
CH061335A	WINN DIXIE PHARMACY #1432	3300 PARIS RD		CHALMETTE	LA	70043	07/01/2016	11/15/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/23/2024 1:07:55 PM	2/26/2025 6:53:45 PM	2/26/2025 6:53 PM
Details	Last Recertification Date	Update	Recertification	2/28/2023 5:42:49 PM	2/23/2024 1:07:55 PM	2/23/2024 1:07 PM
Addresses	Shipping Address	Update	Change Request	Access Health Louisiana Pharmacy Slidell 501 Robert Blvd Suite 100 Slidell, LA 70458	Access Health Louisiana Pharmacy-Kenner 671 W. Esplanade Avenue Suite 120 Kenner, LA 70065	10/20/2023 4:02 PM
Details	Last Recertification Date	Update	Recertification	2/25/2022 12:17:01 PM	2/28/2023 5:42:49 PM	2/28/2023 5:42 PM
Addresses	Shipping Address	Insert	Change Request		Access Health Louisiana Pharmacy Slidell 501 Robert Blvd Suite 100 Slidell, LA 70458	3/8/2022 1:44 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1467108100	3/8/2022 1:44 PM
Medicaid Billing	NPI: State	Insert	Change Request		LA	3/8/2022 1:44 PM
Details	Last Recertification Date	Update	Recertification	2/5/2021 12:56:46 PM	2/25/2022 12:17:01 PM	2/25/2022 12:17 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/5/2021 12:56 PM
Details	Last Recertification Date	Update	Recertification	1/29/2020 11:07:39 AM	2/5/2021 12:56:46 PM	2/5/2021 12:56 PM
Details	Last Recertification Date	Update	Recertification	2/5/2019 3:40:27 PM	1/29/2020 11:07:39 AM	1/29/2020 11:07 AM
Contacts	Primary Contact	Update	Change Request	Gould, Samantha 340B Program Manager Access Health Louisiana 5045753743	Johnson, Shikenya 340B Program Coordinator Access Health Louisiana 5045753743	8/14/2019 2:27 PM
Details	Last Recertification Date	Update	Recertification	2/27/2018 12:09:54 PM	2/5/2019 3:40:27 PM	2/5/2019 3:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/27/2018 12:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2205447	2/27/2018 12:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	2/27/2018 12:09 PM
Details	Last Recertification Date	Update	Recertification	1/26/2017 12:00:00 AM	2/27/2018 12:09:54 PM	2/27/2018 12:09 PM
Addresses	Billing Address	Insert	Change Request		Access Health Louisiana 843 Milling Avenue Luling, LA 70070	11/17/2017 3:28 PM
Addresses	Shipping Address	Insert	Change Request		Access Health Louisiana Pharmacy 843 Milling Avenue Suite 110 Luling, LA 70070	11/17/2017 3:28 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1174035299	11/17/2017 3:28 PM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		11/17/2017 3:28 PM
Contacts	Authorizing Official	Update		KEISER, MARK F. CEO 5045753746	KEISER, MARK F. CEO Access Health Louisiana 5045753746	9/26/2017 5:10 PM
Contacts	Signed By	Update		KEISER, MARK F. CEO 5045753746	KEISER, MARK F. CEO Access Health Louisiana 5045753746	9/26/2017 5:10 PM
Contacts	Primary Contact	Update		Gould, Samantha 340B Program Manager 5045753743	Gould, Samantha 340B Program Manager Access Health Louisiana 5045753743	9/19/2017 10:27 AM
Contacts	Authorizing Official	Insert			KEISER, MARK F. CEO 5045753746	7/6/2017 4:46 PM
Contacts	Signed By	Insert			KEISER, MARK F. CEO 5045753746	7/6/2017 4:46 PM
Contacts	Primary Contact	Update		Breitling, Andrew J. 340B Program Manager 5045753747	Gould, Samantha 340B Program Manager 5045753743	5/24/2017 10:19 AM
Addresses	Main Address	Insert			2900 Indiana Avenue Kenner, LA 70065-4605	1/26/2017 12:20 PM
Details	Last Recertification Date	Update			1/26/2017 12:00:00 AM	1/26/2017 12:20 PM
Contacts	Primary Contact	Insert			Breitling, Andrew J. 340B Program Manager 5045753747	7/8/2016 2:10 PM
Dates	Participating Approval Date	Update			4/11/2016 12:00:00 AM	4/11/2016 4:58 PM
Details	State	Update		Pending	Active	4/11/2016 4:58 PM
Dates	Start Date	Update			7/1/2016 12:00:00 AM	4/11/2016 4:58 PM
Details	340B ID	Update		ONLINE_REG_59028	CH061335AA	4/6/2016 10:43 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_59028	4/5/2016 2:35 PM
Details	Last Recertification Date	Insert				4/5/2016 2:35 PM
Details	Grant Number	Insert			H80CS00867	4/5/2016 2:35 PM
Details	340B ID	Insert			ONLINE_REG	4/5/2016 2:35 PM
Details	Is Authorizing Official EHB Data	Insert			False	4/5/2016 2:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/5/2016 2:35 PM
Details	Medicare Provider Number	Insert				4/5/2016 2:35 PM
Details	Entity Name	Insert			ST. CHARLES COMMUNITY HEALTH CENTER, INC.	4/5/2016 2:35 PM
Details	Program Code	Insert			CH	4/5/2016 2:35 PM
Details	Entity Subname	Insert			Access Health Louisiana Kenner	4/5/2016 2:35 PM
Dates	Participating Approval Date	Insert				4/5/2016 2:35 PM
Details	State	Insert			Pending	4/5/2016 2:35 PM
Dates	Registration Date	Insert			4/5/2016 12:00:00 AM	4/5/2016 2:35 PM
Dates	Signed By Date	Insert			4/5/2016 12:00:00 AM	4/5/2016 2:35 PM
Dates	Start Date	Insert				4/5/2016 2:35 PM
Terminations	Termination Comments	Insert				4/5/2016 2:35 PM
Terminations	Termination Date	Insert				4/5/2016 2:35 PM
Terminations	Termination Effective Date	Insert				4/5/2016 2:35 PM
Terminations	Termination Reason	Insert				4/5/2016 2:35 PM

340B Drug Pricing Program Database